Provider Demographics
NPI:1679796445
Name:HAWES, JEONGHYE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JEONGHYE
Middle Name:
Last Name:HAWES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:SACHA
Other - Middle Name:
Other - Last Name:HAWES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:167 HONEYSUCKLE CIR
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-8502
Mailing Address - Country:US
Mailing Address - Phone:970-948-7014
Mailing Address - Fax:970-858-0319
Practice Address - Street 1:4112 OUTLOOK BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:719-553-1051
Practice Address - Fax:719-553-1100
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17014183500000X
NV16273183500000X
WAPH00055755183500000X
CARPH-57938183500000X
HIPH-2400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist