Provider Demographics
NPI:1710015078
Name:HAWKEYS INC OF COLUMBUS GROVE
Entity Type:Organization
Organization Name:HAWKEYS INC OF COLUMBUS GROVE
Other - Org Name:HAWKEYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER.PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D,RPH
Authorized Official - Phone:419-659-2366
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-0126
Mailing Address - Country:US
Mailing Address - Phone:419-659-2366
Mailing Address - Fax:419-659-2346
Practice Address - Street 1:114 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS GROVE
Practice Address - State:OH
Practice Address - Zip Code:45830-1239
Practice Address - Country:US
Practice Address - Phone:419-659-2366
Practice Address - Fax:419-659-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
OH020164850033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072580OtherPK
OH3753424Medicaid
0474430001Medicare NSC