Provider Demographics
NPI:1790256360
Name:HAMMONDS, AMY KORINNE (DPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KORINNE
Last Name:HAMMONDS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-3973
Mailing Address - Country:US
Mailing Address - Phone:580-584-3353
Mailing Address - Fax:580-584-9459
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-3973
Practice Address - Country:US
Practice Address - Phone:580-584-3353
Practice Address - Fax:580-584-9459
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist