Provider Demographics
NPI:1588265797
Name:HAMILTON, JULIE ANN
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20992 EASTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:MO
Mailing Address - Zip Code:63459-5025
Mailing Address - Country:US
Mailing Address - Phone:573-406-3117
Mailing Address - Fax:
Practice Address - Street 1:3650 STARDUST DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2480
Practice Address - Country:US
Practice Address - Phone:573-406-0682
Practice Address - Fax:573-406-0462
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist