Healthcare Provider Details

I. General information

NPI: 1639449143
Provider Name (Legal Business Name): PAUL R HAMMEKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2012
Last Update Date: 01/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ROUTE 9 STE 100
WARETOWN NJ
08758-1751
US

IV. Provider business mailing address

501 ROUTE 9 STE 100
WARETOWN NJ
08758-1751
US

V. Phone/Fax

Practice location:
  • Phone: 609-971-6002
  • Fax: 609-971-0257
Mailing address:
  • Phone: 609-971-6002
  • Fax: 609-971-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02686100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: