Provider Demographics
NPI:1104108422
Name:HACKNEY, HOWARD W (RPH)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:W
Last Name:HACKNEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 S. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216
Mailing Address - Country:US
Mailing Address - Phone:316-529-1788
Mailing Address - Fax:
Practice Address - Street 1:5555 S. BROADWAY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216
Practice Address - Country:US
Practice Address - Phone:316-529-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-09960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist