Provider Demographics
NPI:1457679490
Name:HACKLAND, PETER L (RPH PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:HACKLAND
Suffix:
Gender:M
Credentials:RPH PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SUTTON WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5393
Mailing Address - Country:US
Mailing Address - Phone:530-273-6652
Mailing Address - Fax:530-273-1358
Practice Address - Street 1:720 SUTTON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5393
Practice Address - Country:US
Practice Address - Phone:530-273-6652
Practice Address - Fax:530-273-1358
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist