Provider Demographics
NPI:1114251337
Name:HAWTHORNE LUGOFF PHARMACY, LLC
Entity Type:Organization
Organization Name:HAWTHORNE LUGOFF PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-227-4464
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-0638
Mailing Address - Country:US
Mailing Address - Phone:803-408-9589
Mailing Address - Fax:803-408-9854
Practice Address - Street 1:814 HIGHWAY 1 S
Practice Address - Street 2:SUITE 4
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-8855
Practice Address - Country:US
Practice Address - Phone:803-408-9589
Practice Address - Fax:803-408-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPENDING333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy