Provider Demographics
NPI:1659970606
Name:HAWKS, MARTHA SUZANNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:SUZANNE
Last Name:HAWKS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MAYNARD
Other - Last Name:HAWKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1187 N HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-4084
Mailing Address - Country:US
Mailing Address - Phone:606-376-2911
Mailing Address - Fax:606-376-2913
Practice Address - Street 1:1187 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-4084
Practice Address - Country:US
Practice Address - Phone:606-376-2911
Practice Address - Fax:606-376-2913
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP0107511835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist