Provider Demographics
NPI:1821573932
Name:HACKER, QUINTIN ANDREW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:QUINTIN
Middle Name:ANDREW
Last Name:HACKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 WATERCHASE WAY SW APT 103
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-5945
Mailing Address - Country:US
Mailing Address - Phone:317-258-6419
Mailing Address - Fax:
Practice Address - Street 1:550 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-9753
Practice Address - Country:US
Practice Address - Phone:616-667-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302046860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist