Provider Demographics
NPI:1558250290
Name:HAMMOND, AMANDA RAE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W237S9710 PAR AVE
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9567
Mailing Address - Country:US
Mailing Address - Phone:262-408-0670
Mailing Address - Fax:
Practice Address - Street 1:N65W25055 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-2671
Practice Address - Country:US
Practice Address - Phone:262-820-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23021-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist