Provider Demographics
NPI:1164419479
Name:HAMILTON, MICHAEL LAWRENCE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16610 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:VA
Mailing Address - Zip Code:24283-3514
Mailing Address - Country:US
Mailing Address - Phone:276-762-9080
Mailing Address - Fax:276-762-9081
Practice Address - Street 1:16610 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:VA
Practice Address - Zip Code:24283-3514
Practice Address - Country:US
Practice Address - Phone:276-762-9080
Practice Address - Fax:276-762-9081
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5362300001Medicare ID - Type Unspecified