Provider Demographics
NPI:1477691962
Name:HAWTHORNE WINNSBORO PHARMACY INC.
Entity Type:Organization
Organization Name:HAWTHORNE WINNSBORO PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:SPIRES
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-227-4464
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-0085
Mailing Address - Country:US
Mailing Address - Phone:803-635-3565
Mailing Address - Fax:803-815-0396
Practice Address - Street 1:110 S CONGRESS ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-1104
Practice Address - Country:US
Practice Address - Phone:803-635-3565
Practice Address - Fax:803-815-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16920333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4218245OtherNABPA
SC4218245OtherNABPA