Provider Demographics
NPI:1215011341
Name:HACKETTS DISCOUNT DRUGS INC
Entity Type:Organization
Organization Name:HACKETTS DISCOUNT DRUGS INC
Other - Org Name:HACKETTS DISCOUNT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:615-735-1616
Mailing Address - Street 1:70 DIXON SPRINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1063
Mailing Address - Country:US
Mailing Address - Phone:615-735-1616
Mailing Address - Fax:615-735-1076
Practice Address - Street 1:70 DIXON SPRINGS HWY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1063
Practice Address - Country:US
Practice Address - Phone:615-735-1616
Practice Address - Fax:615-735-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN00000003223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452472Medicaid
2089847OtherPK
1240270001Medicare NSC