Provider Demographics
NPI:1942816095
Name:HACKETT, STEPHANIE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:HACKETT
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 1:23548 ROAD T
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-9190
Mailing Address - Country:US
Mailing Address - Phone:970-739-5999
Mailing Address - Fax:
Practice Address - Street 1:508 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3307
Practice Address - Country:US
Practice Address - Phone:970-565-6466
Practice Address - Fax:970-565-2152
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK163154183500000X
CO24244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist