Provider Demographics
NPI:1447737895
Name:HAWKINS, BLAKE LANIER (PHARM D)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:LANIER
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CREEKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1212
Mailing Address - Country:US
Mailing Address - Phone:864-678-0880
Mailing Address - Fax:
Practice Address - Street 1:5895 REIDVILLE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:SC
Practice Address - Zip Code:29369-8409
Practice Address - Country:US
Practice Address - Phone:864-486-6990
Practice Address - Fax:864-486-6996
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty