Provider Demographics
NPI:1689954141
Name:HAMILTON, JEANINE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:MARIE
Last Name:HAMILTON
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 1:11980 FULTON ST E
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-9428
Mailing Address - Country:US
Mailing Address - Phone:616-897-3160
Mailing Address - Fax:616-897-4132
Practice Address - Street 1:11980 FULTON ST E
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9428
Practice Address - Country:US
Practice Address - Phone:616-897-3160
Practice Address - Fax:616-897-4132
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist