Healthcare Provider Details

I. General information

NPI: 1598224743
Provider Name (Legal Business Name): E. A. HAWSE HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S GROVE ST
PETERSBURG WV
26847-1804
US

IV. Provider business mailing address

PO BOX 97
WARDENSVILLE WV
26851-0097
US

V. Phone/Fax

Practice location:
  • Phone: 304-530-6101
  • Fax: 304-530-6103
Mailing address:
  • Phone: 304-874-3687
  • Fax: 304-874-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES HARRISON ROHRBAUGH
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 304-874-3687