Provider Demographics
NPI:1639492101
Name:HACKETT, KRISTINE ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:HACKETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:KRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:287 I U WILLETS RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-2217
Mailing Address - Country:US
Mailing Address - Phone:201-981-5686
Mailing Address - Fax:
Practice Address - Street 1:5369 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-6704
Practice Address - Country:US
Practice Address - Phone:800-203-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0508361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist