Provider Demographics
NPI:1407356694
Name:HAMMOND, MALISSA JOANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:JOANNE
Last Name:HAMMOND
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 1:5415 MAY CIR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3879
Mailing Address - Country:US
Mailing Address - Phone:785-750-2887
Mailing Address - Fax:
Practice Address - Street 1:3034 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5806
Practice Address - Country:US
Practice Address - Phone:785-760-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist