Provider Demographics
NPI:1922082239
Name:HACKETT, GEORGE RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:RICHARD
Last Name:HACKETT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9065
Mailing Address - Country:US
Mailing Address - Phone:330-262-8512
Mailing Address - Fax:
Practice Address - Street 1:1114 W HIGH ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1438
Practice Address - Country:US
Practice Address - Phone:330-684-1501
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-12557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist