Provider Demographics
NPI:1639486616
Name:HAMILTON, DESIREA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DESIREA
Middle Name:
Last Name:HAMILTON
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 1:11250 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1088
Mailing Address - Country:US
Mailing Address - Phone:904-262-4250
Mailing Address - Fax:
Practice Address - Street 1:11250 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1088
Practice Address - Country:US
Practice Address - Phone:904-262-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-11
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist