Provider Demographics
NPI:1912557810
Name:HACKER, KAITLIN ROSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:ROSE
Last Name:HACKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MASON PL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1615
Mailing Address - Country:US
Mailing Address - Phone:716-650-8394
Mailing Address - Fax:
Practice Address - Street 1:480 EVANS ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5670
Practice Address - Country:US
Practice Address - Phone:716-632-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist