=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508403502
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER HAMMOND PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2019
-----------------------------------------------------
Last Update Date | 02/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 COMMONS DR
-----------------------------------------------------
City | MAUMELLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72113-7266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-210-7671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 COMMONS DR # Q
-----------------------------------------------------
City | MAUMELLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72113-7266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-837-4167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PD008584
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | PD08584
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------