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NPI Code Detail

MEDICARE: HACKLEY PROFESSIONAL PHARMACY

MEDICARE: HACKLEY PROFESSIONAL PHARMACY
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
13336C0002XClinic Pharmacy
23336C0004XCompounding Pharmacy
33336C0003XCommunity/Retail Pharmacy1852218MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12369153OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1578602520
Entity Type Code : Organization
Provider Name (Legal Business Name) : HACKLEY PROFESSIONAL PHARMACY
Provider Business Mailing Address
First Line : 905 E COLBY ST
Second Line :
City : WHITEHALL
State : MI
Zip : 49461-1262
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 905 E COLBY ST
Second Line :
City : WHITEHALL
State : MI
Zip : 49461-1262
Country : US
Telephone Number : 231-728-5974
Fax Number : 231-728-1604
Authorized Official
Title or Position : DIRECTOR OF PHARMACY
Name : CARLTON BOSSE
Credential :
Telephone Number : 231-728-5974
Provider Enumeration Date : 02/06/2007
Last Update Date : 04/30/2009

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Directions to “HACKLEY PROFESSIONAL PHARMACY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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