Provider Demographics
NPI:1528341393
Name:HAECKER, WAYLON ANTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WAYLON
Middle Name:ANTON
Last Name:HAECKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9402 HIGHWAY 6
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5100
Mailing Address - Country:US
Mailing Address - Phone:281-915-0793
Mailing Address - Fax:281-915-0793
Practice Address - Street 1:9402 HIGHWAY 6
Practice Address - Street 2:SUITE 400
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5100
Practice Address - Country:US
Practice Address - Phone:281-915-0793
Practice Address - Fax:281-915-0793
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist