Individual
KEYON LAMAR HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
636 SOUTHEAST 1ST, BELLE GLADE, FL 33430
(617) 710-3158
Mailing address
636 SE 1ST ST, BELLE GLADE, FL 33430
(617) 710-3158
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
201253779
FL
183700000X
Pharmacy Technician
Primary
RPT36741
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3416L0300X
LAND TRANSPORT MEDICAL COURIER
FL
Enumeration date
09/12/2012
Last updated
09/12/2012
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