Provider Demographics
NPI:1730436932
Name:WESSON, TINA HAWKINS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:HAWKINS
Last Name:WESSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28017-0938
Mailing Address - Country:US
Mailing Address - Phone:704-434-6560
Mailing Address - Fax:704-434-5389
Practice Address - Street 1:105 E. COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28017
Practice Address - Country:US
Practice Address - Phone:704-434-6560
Practice Address - Fax:704-434-5389
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0235671Medicaid