Provider Demographics
NPI:1134737695
Name:HAWKINS, DAMON (DPH)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist