=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902496573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMILTON HEALTH CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2021
-----------------------------------------------------
Last Update Date | 08/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 S 17TH ST
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17104-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-232-9971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 S 17TH ST
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17104-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-232-9971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | IEISHA JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-232-9971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------