Provider Demographics
NPI:1285908582
Name:HACKLEBUG PHARMACY INC.
Entity type:Organization
Organization Name:HACKLEBUG PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-516-4659
Mailing Address - Street 1:34863 US HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:HACKLEBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35564
Mailing Address - Country:US
Mailing Address - Phone:205-516-4659
Mailing Address - Fax:205-935-3779
Practice Address - Street 1:34863 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:HACKLEBURG
Practice Address - State:AL
Practice Address - Zip Code:35564
Practice Address - Country:US
Practice Address - Phone:205-516-4659
Practice Address - Fax:205-935-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy