Provider Demographics
NPI:1538215058
Name:HODGES, JAMES LEROW (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEROW
Last Name:HODGES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N PARLER AVE # NORTH
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-2224
Mailing Address - Country:US
Mailing Address - Phone:843-563-3034
Mailing Address - Fax:843-563-3035
Practice Address - Street 1:204 N PARLER AVE # NORTH
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2224
Practice Address - Country:US
Practice Address - Phone:843-563-3034
Practice Address - Fax:843-563-3035
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC003959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC719388Medicaid
SC719388Medicaid