Provider Demographics
NPI:1437678141
Name:HASLETT PHARMACY LLC
Entity Type:Organization
Organization Name:HASLETT PHARMACY LLC
Other - Org Name:CENTRAL PHARMACY - HASLETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDAGATLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-992-5101
Mailing Address - Street 1:1620 HASLETT RD STE B
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8457
Mailing Address - Country:US
Mailing Address - Phone:517-339-0300
Mailing Address - Fax:517-339-0333
Practice Address - Street 1:1620 HASLETT RD STE B
Practice Address - Street 2:
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8457
Practice Address - Country:US
Practice Address - Phone:517-339-0300
Practice Address - Fax:517-339-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2171473OtherPK