Provider Demographics
NPI:1770006264
Name:HAWKS, BRITTANY NICOLE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICOLE
Last Name:HAWKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15134 FANCY GAP HWY
Mailing Address - Street 2:
Mailing Address - City:CANA
Mailing Address - State:VA
Mailing Address - Zip Code:24317-3575
Mailing Address - Country:US
Mailing Address - Phone:276-733-2482
Mailing Address - Fax:
Practice Address - Street 1:114 E LEBANON ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3662
Practice Address - Country:US
Practice Address - Phone:336-786-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist