Provider Demographics
NPI:1639449143
Name:HAMMEKE, PAUL R
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:HAMMEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ROUTE 9 STE 100
Mailing Address - Street 2:
Mailing Address - City:WARETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08758-1751
Mailing Address - Country:US
Mailing Address - Phone:609-971-6002
Mailing Address - Fax:609-971-0257
Practice Address - Street 1:501 ROUTE 9 STE 100
Practice Address - Street 2:
Practice Address - City:WARETOWN
Practice Address - State:NJ
Practice Address - Zip Code:08758-1751
Practice Address - Country:US
Practice Address - Phone:609-971-6002
Practice Address - Fax:609-971-0257
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02686100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist