Provider Demographics
NPI:1952763898
Name:HAWTHORNE AIKEN PHARMACY INC
Entity Type:Organization
Organization Name:HAWTHORNE AIKEN PHARMACY INC
Other - Org Name:HAWTHORNE AIKEN PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-227-4464
Mailing Address - Street 1:210 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6334
Mailing Address - Country:US
Mailing Address - Phone:803-648-2985
Mailing Address - Fax:803-648-0120
Practice Address - Street 1:410 UNIVERSITY PKWY STE 2800
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6827
Practice Address - Country:US
Practice Address - Phone:803-648-2985
Practice Address - Fax:803-648-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-21
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16457333600000X
333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159296OtherPK
SC716457Medicaid