Healthcare Provider Details

I. General information

NPI: 1770684664
Provider Name (Legal Business Name): JOHN MUNDY HAMMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 259
YELLOW SPRING WV
26865-0177
US

IV. Provider business mailing address

PO BOX 177 ROUTE 259
YELLOW SPRING WV
26865-0177
US

V. Phone/Fax

Practice location:
  • Phone: 304-874-4115
  • Fax:
Mailing address:
  • Phone: 304-874-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0006132
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: