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General NPI Number Information
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NPI Number | 1962417576
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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 | 07/30/2006
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 6401 PRAIRIE ST STE 1100
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City | NORTON SHORES
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State | MI
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Zip | 49444-7839
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Country | US
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Telephone | 231-672-7821
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Fax | 231-727-7971
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Provider Business Mailing Address
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Address Line | 6401 PRAIRIE ST STE 1100
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City | NORTON SHORES
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State | MI
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Zip | 49444-7839
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Country | US
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Telephone | 231-672-7821
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Fax | 231-727-7971
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Authorized Official
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Title or Position | VP OF 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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008308
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License Number State | MI
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