Provider Demographics
NPI:1003115205
Name:HACKMAN, JOHN D (BSPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:HACKMAN
Suffix:
Gender:M
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29965 WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6403
Mailing Address - Country:US
Mailing Address - Phone:440-835-3469
Mailing Address - Fax:
Practice Address - Street 1:479 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044-1257
Practice Address - Country:US
Practice Address - Phone:440-926-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-13286183500000X
FLPS 20025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist