MEDICARE: MRS. KRISTINE ELIZABETH 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	0508361	NY

General Provider Information

NPI Number	:	1639492101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINE ELIZABETH HACKETT RPH

Provider Business Mailing Address
First Line	:	287 I U WILLETS RD
Second Line	:
City	:	ALBERTSON
State	:	NY
Zip	:	11507-2217
Country	:	US
Telephone Number	:	201-981-5686
Fax Number	:

Provider Business Practice Location Address
First Line	:	5369 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6704
Country	:	US
Telephone Number	:	800-203-6282
Fax Number	:

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

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	11/08/2023

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