Provider Demographics
NPI:1396258901
Name:HAMILTON, MELODIE (CPHT)
Entity type:Individual
Prefix:MRS
First Name:MELODIE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 E BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8102
Mailing Address - Country:US
Mailing Address - Phone:813-681-9858
Mailing Address - Fax:813-661-3602
Practice Address - Street 1:179 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8102
Practice Address - Country:US
Practice Address - Phone:813-681-9858
Practice Address - Fax:813-661-3602
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659692959OtherRETAIL PHARMACY
1659392959OtherPHARMACY