Provider Demographics
NPI:1871007443
Name:HAWTHORN PHARMA LLC
Entity Type:Organization
Organization Name:HAWTHORN PHARMA LLC
Other - Org Name:PHARMAHEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SREENIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ATHULURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-998-7888
Mailing Address - Street 1:827 ROCKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2701
Mailing Address - Country:US
Mailing Address - Phone:508-998-7888
Mailing Address - Fax:508-998-9866
Practice Address - Street 1:827 ROCKDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2701
Practice Address - Country:US
Practice Address - Phone:508-998-7888
Practice Address - Fax:508-997-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-18
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110131979AMedicaid