Provider Demographics
NPI:1275964397
Name:HAKALMAZIAN, GREGG
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:HAKALMAZIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5817
Mailing Address - Country:US
Mailing Address - Phone:708-552-9005
Mailing Address - Fax:708-552-9012
Practice Address - Street 1:7300 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5817
Practice Address - Country:US
Practice Address - Phone:708-552-9005
Practice Address - Fax:708-552-9012
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-30
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051032933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist