Provider Demographics
NPI:1558550467
Name:HAMMILL, MELISSA MARIE (PHARMD, BCACP)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:HAMMILL
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:KOXLIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BCACP
Mailing Address - Street 1:2622 VARGAS WAY
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1751
Mailing Address - Country:US
Mailing Address - Phone:608-751-4812
Mailing Address - Fax:
Practice Address - Street 1:901 SILVER SPUR RD
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3805
Practice Address - Country:US
Practice Address - Phone:608-751-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15951040183500000X
CA72768183500000X
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program