Provider Demographics
NPI:1578580049
Name:HAWLEY, LARRY W (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:W
Last Name:HAWLEY
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 1:3050 ORCHARD ROAD
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094
Mailing Address - Country:US
Mailing Address - Phone:770-918-0822
Mailing Address - Fax:
Practice Address - Street 1:2455 SALEM RD SE
Practice Address - Street 2:INGLES PHARMACY #469
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013
Practice Address - Country:US
Practice Address - Phone:770-922-3507
Practice Address - Fax:770-922-4498
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12361183500000X
WY2015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist