Provider Demographics
NPI:1083972202
Name:HACKLEBURG PHARMACY INC
Entity Type:Organization
Organization Name:HACKLEBURG PHARMACY INC
Other - Org Name:HACKLEBURG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-935-3392
Mailing Address - Street 1:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:HACKLEBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35564-0167
Mailing Address - Country:US
Mailing Address - Phone:205-935-3392
Mailing Address - Fax:205-935-3393
Practice Address - Street 1:34863 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:HACKLEBURG
Practice Address - State:AL
Practice Address - Zip Code:35564-4281
Practice Address - Country:US
Practice Address - Phone:205-935-3392
Practice Address - Fax:205-935-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1138913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0137770OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0137770OtherNCPDP PROVIDER IDENTIFICATION NUMBER