Provider Demographics
NPI:1295002962
Name:HAMILTON, JACK MILLER (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:MILLER
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 GEORGETOWN PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3062
Mailing Address - Country:US
Mailing Address - Phone:773-710-8290
Mailing Address - Fax:
Practice Address - Street 1:822 GEORGETOWN PL
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3062
Practice Address - Country:US
Practice Address - Phone:773-710-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist