Provider Demographics
NPI:1306020151
Name:HAMM, KATHY MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:MARIE
Last Name:HAMM
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 1:3014 SE GLADSTONE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3554
Mailing Address - Country:US
Mailing Address - Phone:503-261-7900
Mailing Address - Fax:503-249-3438
Practice Address - Street 1:3014 SE GLADSTONE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3554
Practice Address - Country:US
Practice Address - Phone:503-261-7900
Practice Address - Fax:503-249-3438
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist