Provider Demographics
NPI:1710367677
Name:HAWTHORN DRUG GROUP INC
Entity Type:Organization
Organization Name:HAWTHORN DRUG GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BULTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-621-2010
Mailing Address - Street 1:21 DESIGN DR.
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3019
Mailing Address - Country:US
Mailing Address - Phone:888-405-9981
Mailing Address - Fax:866-683-7962
Practice Address - Street 1:21 DESIGN DR.
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3019
Practice Address - Country:US
Practice Address - Phone:888-405-9981
Practice Address - Fax:866-683-7962
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCORDIA HELATHCARE USA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy