=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588291728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN F HAMMES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2020
-----------------------------------------------------
Last Update Date | 03/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | W63N152 WASHINGTON AVE
-----------------------------------------------------
City | CEDARBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53012-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-377-5685
-----------------------------------------------------
Fax | 262-377-1940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 279 HIGH FOREST DR
-----------------------------------------------------
City | CEDARBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53012-9140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-914-2245
-----------------------------------------------------
Fax | 262-377-1940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8238-40
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------