MEDICARE: SUSAN PHILLIPS HAMM RPH

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	PH00011177	WA

General Provider Information

NPI Number	:	1568764462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PHILLIPS HAMM RPH

Provider Business Mailing Address
First Line	:	8340 15TH AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-3603
Country	:	US
Telephone Number	:	206-782-7480
Fax Number	:	206-782-7842

Provider Business Practice Location Address
First Line	:	8340 15TH AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-3603
Country	:	US
Telephone Number	:	206-782-7480
Fax Number	:	206-782-7842

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

Provider Enumeration Date	:	11/27/2010
Last Update Date	:	11/27/2010

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