MEDICARE: MR. GARY LEE HACKETT RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH29152	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982612917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY LEE HACKETT RPH

Provider Business Mailing Address
First Line	:	3645 EUREKA WAY
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-0177
Country	:	US
Telephone Number	:	530-243-5313
Fax Number	:	530-243-1576

Provider Business Practice Location Address
First Line	:	3645 EUREKA WAY
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-0177
Country	:	US
Telephone Number	:	530-243-5313
Fax Number	:	530-243-1576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	03/19/2011

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