Provider Demographics
NPI:1407103864
Name:HAWKINS, RAYMOND LA RANCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:LA RANCE
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11613 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3820
Mailing Address - Country:US
Mailing Address - Phone:214-361-9228
Mailing Address - Fax:
Practice Address - Street 1:11613 N CENTRAL EXPY
Practice Address - Street 2:SUITE 114
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3820
Practice Address - Country:US
Practice Address - Phone:214-361-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-04
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist