Provider Demographics
NPI:1104099290
Name:HEWKIN, JOHN WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WAYNE
Last Name:HEWKIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX I
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-0049
Mailing Address - Country:US
Mailing Address - Phone:573-885-7212
Mailing Address - Fax:573-885-6798
Practice Address - Street 1:200 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1705
Practice Address - Country:US
Practice Address - Phone:573-885-7212
Practice Address - Fax:573-885-6798
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO41734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist