Provider Demographics
NPI:1770684664
Name:HAMMOND, JOHN MUNDY
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MUNDY
Last Name:HAMMOND
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:PO BOX 177
Mailing Address - Street 2:ROUTE 259
Mailing Address - City:YELLOW SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:26865-0177
Mailing Address - Country:US
Mailing Address - Phone:304-874-4115
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 259
Practice Address - Street 2:
Practice Address - City:YELLOW SPRING
Practice Address - State:WV
Practice Address - Zip Code:26865-0177
Practice Address - Country:US
Practice Address - Phone:304-874-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist