Provider Demographics
NPI:1508153628
Name:HAWES, SUSAN GELENE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GELENE
Last Name:HAWES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 NE PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1733
Mailing Address - Country:US
Mailing Address - Phone:239-829-2650
Mailing Address - Fax:
Practice Address - Street 1:1890 NE PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1733
Practice Address - Country:US
Practice Address - Phone:239-829-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015831A183500000X
FLPS 53196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist