Provider Demographics
NPI:1891078143
Name:HAWKINS, LONNIE D (RPH)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:D
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CASTLEKEEP
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-7828
Mailing Address - Country:US
Mailing Address - Phone:417-350-6636
Mailing Address - Fax:
Practice Address - Street 1:1260 SPUR DR
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2350
Practice Address - Country:US
Practice Address - Phone:417-859-5394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist