Provider Demographics
NPI:1225227283
Name:HAMILTON, REBECCA (RPH)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1987
Mailing Address - Country:US
Mailing Address - Phone:262-687-2150
Mailing Address - Fax:262-687-5500
Practice Address - Street 1:1244 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1987
Practice Address - Country:US
Practice Address - Phone:262-687-2150
Practice Address - Fax:262-687-5500
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12782-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist