Provider Demographics
NPI:1386920734
Name:HAMILTON, MICHAEL DWAYNE (DPH, RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DWAYNE
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DPH, RPH
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:DWAYNE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPH, RPH
Mailing Address - Street 1:PO BOX 90635
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77290-0635
Mailing Address - Country:US
Mailing Address - Phone:936-203-8499
Mailing Address - Fax:
Practice Address - Street 1:10021 SOUTH MAIN ST STE B-2A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5224
Practice Address - Country:US
Practice Address - Phone:713-492-2088
Practice Address - Fax:713-554-0425
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127352-1183500000X
OK10459183500000X
NV11056183500000X
TX36578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist