Provider Demographics
NPI:1700690062
Name:HAWKINS, IMAN
Entity type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1206
Mailing Address - Country:US
Mailing Address - Phone:434-348-3181
Mailing Address - Fax:434-348-0671
Practice Address - Street 1:306 W ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1206
Practice Address - Country:US
Practice Address - Phone:434-348-3181
Practice Address - Fax:434-348-0671
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202222588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist