Provider Demographics
NPI:1972854263
Name:HAWKS, THERESA (PHARMD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HAWKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 W ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:AZ
Mailing Address - Zip Code:86046-2334
Mailing Address - Country:US
Mailing Address - Phone:928-635-5977
Mailing Address - Fax:928-635-5984
Practice Address - Street 1:637 W ROUTE 66
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:AZ
Practice Address - Zip Code:86046-2334
Practice Address - Country:US
Practice Address - Phone:928-635-5977
Practice Address - Fax:928-635-5984
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist