Provider Demographics
NPI:1982973772
Name:NORDSTROM HAMMOND, SHELLEY MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:MARIE
Last Name:NORDSTROM HAMMOND
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 1:5865 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-3120
Mailing Address - Country:US
Mailing Address - Phone:662-280-0611
Mailing Address - Fax:
Practice Address - Street 1:1501 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1400
Practice Address - Country:US
Practice Address - Phone:662-342-9283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE09975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist