Provider Demographics
NPI:1699352401
Name:HAWKINS, JANA LEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:LEE
Last Name:HAWKINS
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 1:14895 47TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3404
Mailing Address - Country:US
Mailing Address - Phone:763-486-9348
Mailing Address - Fax:
Practice Address - Street 1:5696 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5579
Practice Address - Country:US
Practice Address - Phone:763-571-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist