MEDICARE: JAY L HAMMERMAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407934482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY L HAMMERMAN RPH

Provider Business Mailing Address
First Line	:	1104 W THORNDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-3516
Country	:	US
Telephone Number	:	773-561-6660
Fax Number	:	773-561-6685

Provider Business Practice Location Address
First Line	:	1104 W THORNDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-3516
Country	:	US
Telephone Number	:	773-561-6660
Fax Number	:	773-561-6685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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