Provider Demographics
NPI:1659654119
Name:HAMM, HALEY (RPH)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:HAMM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4991 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-8717
Mailing Address - Country:US
Mailing Address - Phone:662-393-8564
Mailing Address - Fax:662-393-8705
Practice Address - Street 1:4991 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-8717
Practice Address - Country:US
Practice Address - Phone:662-393-8564
Practice Address - Fax:662-393-8705
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-8806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist