Individual
RAE HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
2102 NEZ PERCE DR, LEWISTON, ID 83501-4116
(208) 743-4434
(208) 743-9422
Mailing address
711 VISTA AVE, LEWISTON, ID 83501-4626
(208) 305-8119
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5082
ID
183500000X
Pharmacist
PH00019210
WA
183500000X
Pharmacist
RPH-0008715
OR
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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