NPIMap

Organization Active NPI

Hawks Prairie Pharmacy

  • Long Term Care Pharmacy
  • Lacey, WA
National Provider Identifier
1376277236
Registry record updated Jul 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
HAWKS PRAIRIE PHARMACY
Practice address
2539 Marvin Rd NE Ste E
Lacey, WA 98516-3175
Phone
(360) 438-3072
Fax
(360) 438-3532
NPI assigned
Jul 14, 2022
Organization subpart
Yes
Parent organization
HAWKS PRAIRIE PHARMACYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sunil B Thimmegowda, RPHNPI 1689906133
Title
President
Phone
(360) 438-3072

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

2539 Marvin Rd NE Ste E
Lacey, WA 98516-3175

Mailing address

2539 Marvin Rd NE Ste E
Lacey, WA 98516-3175
Phone (360) 438-3072

Other identifiers 2

IdentifierTypeStateIssuer
1508292707OtherNPI
2031538MedicaidWA

Other names 2

  • HAWKS PRAIRIE HEALTH MART PHARMACY Doing business as
  • HAWKS PRAIRIE LTC PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hawks Prairie Pharmacy2 organizations share this tax ID, including this one
Part of
Hawks Prairie Pharmacy

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2539 Marvin Rd NE
Ste E
Lacey, WA 98516
Phone (360) 252-2759

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657929600000",
    "number": "1376277236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2539 MARVIN RD NE STE E",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985163175",
            "telephone_number": "360-438-3072",
            "fax_number": "360-438-3532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2539 MARVIN RD NE STE E",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985163175",
            "telephone_number": "360-438-3072",
            "fax_number": "360-438-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWKS PRAIRIE PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAWKS PRAIRIE PHARMACY",
        "enumeration_date": "2022-07-14",
        "last_updated": "2022-07-16",
        "certification_date": "2022-07-16",
        "status": "A",
        "authorized_official_last_name": "THIMMEGOWDA",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-438-3072",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1508292707",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2031538",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAWKS PRAIRIE HEALTH MART PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HAWKS PRAIRIE LTC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.