Healthcare Provider Details

I. General information

NPI: 1366773749
Provider Name (Legal Business Name): E.A. HAWSE HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E. MAIN
WARDENSVILLE WV
26851-0425
US

IV. Provider business mailing address

PO BOX 425
WARDENSVILLE WV
26851-0425
US

V. Phone/Fax

Practice location:
  • Phone: 304-874-3687
  • Fax: 304-874-3692
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 NumberSP0552393
License Number StateWV

VIII. Authorized Official

Name: MR. JOHN M. HAMMOND
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 304-874-3687