MEDICARE: E. A. HAWSE HEALTH CENTER, INC.

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

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

Provider Business Mailing Address
First Line	:	PO BOX 97
Second Line	:
City	:	WARDENSVILLE
State	:	WV
Zip	:	26851-0097
Country	:	US
Telephone Number	:	304-874-3687
Fax Number	:	304-874-3692

Provider Business Practice Location Address
First Line	:	111 S GROVE ST
Second Line	:
City	:	PETERSBURG
State	:	WV
Zip	:	26847-1804
Country	:	US
Telephone Number	:	304-530-6101
Fax Number	:	304-530-6103

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MR. CHARLES HARRISON ROHRBAUGH
Credential	:	RPH
Telephone Number	:	304-874-3687

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	06/11/2019

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