Provider Demographics
NPI:1700173747
Name:HACKNEY, SARAH E (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:E
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W MOUND RD
Mailing Address - Street 2:T-1951
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1965
Mailing Address - Country:US
Mailing Address - Phone:217-875-6550
Mailing Address - Fax:217-875-6550
Practice Address - Street 1:355 W MOUND RD
Practice Address - Street 2:T-1951
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1965
Practice Address - Country:US
Practice Address - Phone:217-875-6550
Practice Address - Fax:217-875-6550
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-290658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist