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General NPI Number Information
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NPI Number | 1578118006
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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 | 08/01/2019
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 2006 HOLTON RD STE 100
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City | NORTH MUSKEGON
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State | MI
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Zip | 49445-1505
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Country | US
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Telephone | 231-672-7824
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Fax |
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Provider Business Mailing Address
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Address Line | 2006 HOLTON RD STE 100
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City | NORTH MUSKEGON
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State | MI
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Zip | 49445-1505
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Country | US
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Telephone | 231-672-7824
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT FINANCE
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Name | KRISTI KAROLE NAGENGAST
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Credential |
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Telephone | 231-728-1950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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