=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225633001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN LEROY HAMMOND JR. RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2020
-----------------------------------------------------
Last Update Date | 12/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 443 CLEVELAND ST
-----------------------------------------------------
City | ELYRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44035-4062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-365-7162
-----------------------------------------------------
Fax | 440-366-5494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 358 YALE AVE
-----------------------------------------------------
City | ELYRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44035-7112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-323-1255
-----------------------------------------------------
Fax | 440-366-5494
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03310049
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------