Provider Demographics
NPI:1356689095
Name:HAMMOND, WAYNE HUDSON (RPH)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:HUDSON
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701 BELCHER RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5135
Mailing Address - Country:US
Mailing Address - Phone:727-523-2515
Mailing Address - Fax:727-523-2536
Practice Address - Street 1:11701 BELCHER RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5135
Practice Address - Country:US
Practice Address - Phone:727-523-2515
Practice Address - Fax:727-523-2536
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL203051835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1080201Medicare UPIN