Provider Demographics
NPI:1952459950
Name:HAWKINS PHARMACY PC
Entity Type:Organization
Organization Name:HAWKINS PHARMACY PC
Other - Org Name:SMITH DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAWKINS
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-596-2411
Mailing Address - Street 1:121 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:OK
Mailing Address - Zip Code:73728-2028
Mailing Address - Country:US
Mailing Address - Phone:580-596-2411
Mailing Address - Fax:580-596-2471
Practice Address - Street 1:121 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:OK
Practice Address - Zip Code:73728-2028
Practice Address - Country:US
Practice Address - Phone:580-596-2411
Practice Address - Fax:580-596-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
OK62-47503336C0003X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100233860AMedicaid
2072702OtherPK
5114370001Medicare NSC