Provider Demographics
NPI:1881748192
Name:HAWKINS, MELODIE TIPTON (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELODIE
Middle Name:TIPTON
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 HINKSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9354
Mailing Address - Country:US
Mailing Address - Phone:859-498-3677
Mailing Address - Fax:606-674-6979
Practice Address - Street 1:60 SLATE AVE
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360
Practice Address - Country:US
Practice Address - Phone:606-674-6979
Practice Address - Fax:606-674-6979
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist