Provider Demographics
NPI:1881944809
Name:HAMILTON, JAZMIN M (PHARMD)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:M
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 1:1105 ISLAND PARK BLVD
Mailing Address - Street 2:#909
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4741
Mailing Address - Country:US
Mailing Address - Phone:318-631-9891
Mailing Address - Fax:
Practice Address - Street 1:2758 W 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-4502
Practice Address - Country:US
Practice Address - Phone:318-631-9891
Practice Address - Fax:318-631-3850
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.019951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist