MEDICARE: DR. JACK MILLER HAMILTON JR. PHARMD, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	61133	CA
2	183500000X	Pharmacist	PH60680447	WA

General Provider Information

NPI Number	:	1295002962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK MILLER HAMILTON JR. PHARMD, MBA

Provider Business Mailing Address
First Line	:	5921 INDIAN TRL NE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98422-4212
Country	:	US
Telephone Number	:	773-710-8290
Fax Number	:

Provider Business Practice Location Address
First Line	:	5921 INDIAN TRL NE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98422-4212
Country	:	US
Telephone Number	:	773-710-8290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	05/15/2025

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