Provider Demographics
NPI:1013008499
Name:HAWK PHARMACY, INC
Entity Type:Organization
Organization Name:HAWK PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIKES
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:940-733-0969
Mailing Address - Street 1:120 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76367-2805
Mailing Address - Country:US
Mailing Address - Phone:940-592-4191
Mailing Address - Fax:940-592-5613
Practice Address - Street 1:120 W PARK AVE
Practice Address - Street 2:
Practice Address - City:IOWA PARK
Practice Address - State:TX
Practice Address - Zip Code:76367
Practice Address - Country:US
Practice Address - Phone:940-592-4191
Practice Address - Fax:940-592-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336L0003X
TX320193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149845Medicaid
TX0680520001Medicare NSC