Provider Demographics
NPI:1326654179
Name:HAWTHORNE COMPOUNDING PHARMACY LLC
Entity Type:Organization
Organization Name:HAWTHORNE COMPOUNDING PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:ULLRICH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-521-0272
Mailing Address - Street 1:100 HAWTHORNE LN STE A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2171
Mailing Address - Country:US
Mailing Address - Phone:706-521-0272
Mailing Address - Fax:706-521-0273
Practice Address - Street 1:100 HAWTHORNE LN STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2171
Practice Address - Country:US
Practice Address - Phone:706-521-0272
Practice Address - Fax:706-521-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy