Provider Demographics
NPI:1447668231
Name:HODGES, SHANE ERIC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:ERIC
Last Name:HODGES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 GOOD HOPE RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6905
Mailing Address - Country:US
Mailing Address - Phone:202-876-2901
Mailing Address - Fax:202-876-2903
Practice Address - Street 1:1117 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6905
Practice Address - Country:US
Practice Address - Phone:202-876-2901
Practice Address - Fax:202-876-2903
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22460OtherMARYLAND BOARD OF PHARMACY