Provider Demographics
NPI:1710577267
Name:HAWK, MICHAEL CONRAD
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CONRAD
Last Name:HAWK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 N POINT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-2413
Mailing Address - Country:US
Mailing Address - Phone:410-284-2424
Mailing Address - Fax:410-284-0601
Practice Address - Street 1:2805 N POINT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-2413
Practice Address - Country:US
Practice Address - Phone:410-284-2424
Practice Address - Fax:410-284-0601
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDV12110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist