Provider Demographics
NPI:1619353505
Name:HACKING, LENE BIRGITTE (RPH)
Entity Type:Individual
Prefix:
First Name:LENE
Middle Name:BIRGITTE
Last Name:HACKING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2504
Mailing Address - Country:US
Mailing Address - Phone:541-687-7620
Mailing Address - Fax:
Practice Address - Street 1:2030 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2504
Practice Address - Country:US
Practice Address - Phone:541-687-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist