Provider Demographics
NPI:1407934482
Name:HAMMERMAN, JAY L (RPH)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:HAMMERMAN
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 1:1104 W THORNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3516
Mailing Address - Country:US
Mailing Address - Phone:773-561-6660
Mailing Address - Fax:773-561-6685
Practice Address - Street 1:1104 W THORNDALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3516
Practice Address - Country:US
Practice Address - Phone:773-561-6660
Practice Address - Fax:773-561-6685
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363704718001Medicaid
IL363704718001Medicaid