Provider Demographics
NPI:1225760564
Name:HAKES, LAVIE-EN ROSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAVIE-EN
Middle Name:ROSE
Last Name:HAKES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 POPLAR SPRINGS BARGERTON RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-7189
Mailing Address - Country:US
Mailing Address - Phone:731-614-9555
Mailing Address - Fax:
Practice Address - Street 1:3144 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3483
Practice Address - Country:US
Practice Address - Phone:731-660-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist