Provider Demographics
NPI:1720874829
Name:HAWTHORN LTC PHARMACY LLC
Entity type:Organization
Organization Name:HAWTHORN LTC PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HYNEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:816-396-7751
Mailing Address - Street 1:2013 S BELT HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2239
Mailing Address - Country:US
Mailing Address - Phone:816-396-7751
Mailing Address - Fax:785-396-7754
Practice Address - Street 1:2013 S BELT HWY STE 100
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2239
Practice Address - Country:US
Practice Address - Phone:816-396-7751
Practice Address - Fax:785-396-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy