Basic Information
| Provider Information | |||||||||
| NPI: | 1003005505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMEN | ||||||||
| FirstName: | SHELLEY | ||||||||
| MiddleName: | RENAE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4910 S YOSEMITE ST | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801111383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037732390 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4910 S YOSEMITE ST | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801111383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037732390 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2007 | ||||||||
| LastUpdateDate: | 08/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 14469 | CO | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 4736 | SD | N | Pharmacy Service Providers | Pharmacist |
No ID Information.