Hawks Prairie Pharmacy

Primary specialty

PharmacyTaxonomy code 333600000X

License

PHAR.CF.60409528 Issued in WA

Legal business name

HAWKS PRAIRIE PHARMACY

Doing business as

Hawks Prairie Health Mart Pharmacy

Practice address

2539 Marvin Rd NE
Ste E
Lacey, WA 98516-3177

Phone

(360) 438-3072

Fax

(360) 438-3532

NPI assigned

Sep 19, 2013

Last updated

Nov 11, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Sunil B ThimmegowdaNPI 1689906133

Title

Owner/Pharmacist

Phone

(360) 438-3072

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• HAWKS PRAIRIE HEALTH MART PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

Tax ID family

Hawks Prairie Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Hawks Prairie Pharmacy

  dba Hawks Prairie Health Mart Pharmacy

  • Long Term Care Pharmacy
  • Lacey, WA
  • NPI 1376277236
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Hawks Prairie Pharmacy

  dba Hawks Prairie Health Mart Pharmacy

  • Long Term Care Pharmacy
  • Lacey, WA
  • NPI 1376277236
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sunil B Thimmegowda

  • Pharmacist
  • Lacey, WA
  • NPI 1689906133
  NPD Authorized official
• Stephanie My-Phuong Su

  • Pharmacist
  • Lacey, WA
  • NPI 1427729920
  NPD

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699660800000",
    "number": "1508292707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2539 MARVIN RD NE",
            "address_2": "STE E",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985163177",
            "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",
            "address_2": "STE E",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985163177",
            "telephone_number": "360-438-3072",
            "fax_number": "360-438-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWKS PRAIRIE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-19",
        "last_updated": "2023-11-11",
        "certification_date": "2023-11-11",
        "status": "A",
        "authorized_official_last_name": "THIMMEGOWDA",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "360-438-3072",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.60409528",
            "primary": true
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE MASS IMMUNIZATION",
            "identifier": "G8924654",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAWKS PRAIRIE HEALTH MART PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HAWKS PRAIRIE HEALTH MART PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Summer Elaine Hatcher
• Amanda Lee Hatt, ARNP
• Hunter Michael Hatton
• Dirk Francis Havlak, MD
• Hawks Prairie Pharmacy (Hawks Prairie Health Mart Pharmacy)
• Hawks Prairie Vision Clinic, P.S.
• Lauren E Hawks
• Joanna Haws, O.D.
• Hope Marie Hayes, LMHCA
• Mindy M Hayes, LMP

• Pharmacy in Lacey, WA
• Providers in Lacey, WA by specialty
• Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.