Provider Demographics
NPI:1841645512
Name:HACKFORD, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HACKFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018
Mailing Address - Country:US
Mailing Address - Phone:610-284-6803
Mailing Address - Fax:
Practice Address - Street 1:5300 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:CLIFTON HTS
Practice Address - State:PA
Practice Address - Zip Code:19018
Practice Address - Country:US
Practice Address - Phone:610-284-6803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045932L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist