Provider Demographics
NPI:1295018364
Name:HAWKES, JEREMY LOWELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LOWELL
Last Name:HAWKES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 RED HEN RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3990
Mailing Address - Country:US
Mailing Address - Phone:801-766-1320
Mailing Address - Fax:
Practice Address - Street 1:1315 N STATE ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2416
Practice Address - Country:US
Practice Address - Phone:801-616-5223
Practice Address - Fax:801-616-5252
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6609157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist