MEDICARE: MR. RAYMOND LA RANCE HAWKINS RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	29902	TX

General Provider Information

NPI Number	:	1407103864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND LA RANCE HAWKINS RPH.

Provider Business Mailing Address
First Line	:	11613 N CENTRAL EXPY
Second Line	:	SUITE 114
City	:	DALLAS
State	:	TX
Zip	:	75243-3820
Country	:	US
Telephone Number	:	214-361-9228
Fax Number	:

Provider Business Practice Location Address
First Line	:	11613 N CENTRAL EXPY
Second Line	:	SUITE 114
City	:	DALLAS
State	:	TX
Zip	:	75243-3820
Country	:	US
Telephone Number	:	214-361-9228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2012
Last Update Date	:	08/04/2012

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