MEDICARE: DR. DESIREA HAMILTON PHARM.D.

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	PS42943	FL

General Provider Information

NPI Number	:	1639486616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DESIREA HAMILTON PHARM.D.

Provider Business Mailing Address
First Line	:	11250 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1088
Country	:	US
Telephone Number	:	904-262-4250
Fax Number	:

Provider Business Practice Location Address
First Line	:	11250 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1088
Country	:	US
Telephone Number	:	904-262-4250
Fax Number	:

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

Provider Enumeration Date	:	09/11/2010
Last Update Date	:	09/11/2010

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