Healthcare Provider Details

I. General information

NPI: 1750454419
Provider Name (Legal Business Name): JOHNNY WADE HAWLEY PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N COLLEGE AVE VETERANS ADMINISTRATION HOSPITAL (119 PHARMACY)
FAYETTEVILLE AR
72703-1944
US

IV. Provider business mailing address

1945 S FESCUE CT
FAYETTEVILLE AR
72701-0822
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-4301
  • Fax:
Mailing address:
  • Phone: 479-790-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPD09552
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: