Provider Demographics
NPI:1306129952
Name:HAWK, ELLEN KAY (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:KAY
Last Name:HAWK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 TOWERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27708-9979
Mailing Address - Country:US
Mailing Address - Phone:919-385-3784
Mailing Address - Fax:
Practice Address - Street 1:305 TOWERVIEW DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27708
Practice Address - Country:US
Practice Address - Phone:919-385-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1508300914Medicaid