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General NPI Number Information
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NPI Number | 1013626639
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Entity Type | Organization
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Legal Business Name | HACKLEY PROFESSIONAL PHARMACY, INC
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 1675 LEAHY ST STE 111
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City | MUSKEGON
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State | MI
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Zip | 49442-5538
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Country | US
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Telephone | 231-672-7822
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Fax | 231-672-8425
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Provider Business Mailing Address
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Address Line | 1675 LEAHY ST STE 111
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City | MUSKEGON
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State | MI
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Zip | 49442-5538
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Country | US
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Telephone | 231-672-7822
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Fax | 231-672-8425
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | TARA ZDYBEL
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Credential | PHARMD
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Telephone | 231-672-4899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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