Healthcare Provider Details

I. General information

NPI: 1003124124
Provider Name (Legal Business Name): JAMES JAY HAWKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4871
US

IV. Provider business mailing address

2313 SILVER CHARM CIR
SUFFOLK VA
23435-3363
US

V. Phone/Fax

Practice location:
  • Phone: 757-382-9717
  • Fax: 757-548-8597
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202004899
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: