Healthcare Provider Details

I. General information

NPI: 1710015078
Provider Name (Legal Business Name): HAWKEYS INC OF COLUMBUS GROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N HIGH ST
COLUMBUS GROVE OH
45830-1239
US

IV. Provider business mailing address

PO BOX 126
COLUMBUS GROVE OH
45830-0126
US

V. Phone/Fax

Practice location:
  • Phone: 419-659-2366
  • Fax: 419-659-2346
Mailing address:
  • Phone: 419-659-2366
  • Fax: 419-659-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number02016485003
License Number StateOH

VIII. Authorized Official

Name: EDWARD CASSIDY
Title or Position: OWNER.PIC,AO
Credential: PHARM D,RPH
Phone: 419-659-2366