Organization
HAWKS PRAIRIE PHARMACY
Active
Other names
HAWKS PRAIRIE HEALTH MART PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SUNIL B THIMMEGOWDA (OWNER/PHARMACIST)
(360) 438-3072
Entity
Organization
Contact information
Practice address
2539 MARVIN RD NE, STE E, LACEY, WA 98516-3177
(360) 438-3072
(360) 438-3532
Mailing address
2539 MARVIN RD NE, STE E, LACEY, WA 98516-3177
(360) 438-3072
(360) 438-3532
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PHAR.CF.60409528
WA
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8924654
MEDICARE MASS IMMUNIZATION
WA
Enumeration date
09/19/2013
Last updated
11/11/2023
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