Provider Demographics
NPI:1073850814
Name:HAWKSHEAD, CHAD (MSN, PHARMD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:HAWKSHEAD
Suffix:
Gender:M
Credentials:MSN, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1420
Mailing Address - Country:US
Mailing Address - Phone:954-328-7665
Mailing Address - Fax:
Practice Address - Street 1:1940 CORDOVA RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2156
Practice Address - Country:US
Practice Address - Phone:954-847-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist