Provider Demographics
NPI:1144388059
Name:HACKLEY, TAMMI L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMI
Middle Name:L
Last Name:HACKLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19316 S MITKOF LOOP
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8600
Mailing Address - Country:US
Mailing Address - Phone:907-696-0130
Mailing Address - Fax:
Practice Address - Street 1:923 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4306
Practice Address - Country:US
Practice Address - Phone:907-343-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT31411835G0303X
AK10741835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric