Healthcare Provider Details

I. General information

NPI: 1083986632
Provider Name (Legal Business Name): MICHAEL HAWKES PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2012
Last Update Date: 01/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S US HIGHWAY 1
JUPITER FL
33477-5117
US

IV. Provider business mailing address

120 W THATCH PALM CIR
JUPITER FL
33458-7174
US

V. Phone/Fax

Practice location:
  • Phone: 561-743-7400
  • Fax:
Mailing address:
  • Phone: 954-895-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS47769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: