Provider Demographics
NPI:1184023491
Name:HACKNEY, GREGORY (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:HACKNEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3721
Mailing Address - Country:US
Mailing Address - Phone:318-448-4841
Mailing Address - Fax:318-448-4491
Practice Address - Street 1:6225 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3721
Practice Address - Country:US
Practice Address - Phone:318-448-4841
Practice Address - Fax:318-448-4491
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist