Individual
VAN HODGES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
201 E 7TH AVE, BRISTOW, OK 74010-2503
(918) 367-3328
(918) 367-2415
Mailing address
201 E 7TH AVE, BRISTOW, OK 74010-2503
(918) 367-3328
(918) 367-2415
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16130
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100236210A
—
OK
Enumeration date
09/24/2020
Last updated
09/24/2020
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