Provider Demographics
NPI:1578644639
Name:HAWKEYE ENTERPRISES LLC
Entity Type:Organization
Organization Name:HAWKEYE ENTERPRISES LLC
Other - Org Name:OLSEN & SON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-349-2221
Mailing Address - Street 1:24106 STATE ROAD 35
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872
Mailing Address - Country:US
Mailing Address - Phone:715-349-2221
Mailing Address - Fax:715-349-7350
Practice Address - Street 1:24106 STATE ROAD 35
Practice Address - Street 2:
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-0000
Practice Address - Country:US
Practice Address - Phone:715-349-2221
Practice Address - Fax:715-349-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8102-0423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5116024OtherNCPDP
WI41725000Medicaid
WI33259100Medicaid
1578644639Medicare NSC