Basic Information
Provider Information
NPI: 1003005505
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAMMEN
FirstName: SHELLEY
MiddleName: RENAE
NamePrefix: MRS.
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X4736SDN Pharmacy Service ProvidersPharmacist 
183500000X14469COY Pharmacy Service ProvidersPharmacist 

No ID Information.


Home