Provider Demographics
NPI:1881148294
Name:HAKANSON, SCARLETTE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:SCARLETTE
Middle Name:MARIE
Last Name:HAKANSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-3101
Mailing Address - Country:US
Mailing Address - Phone:386-427-9161
Mailing Address - Fax:
Practice Address - Street 1:709 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-3101
Practice Address - Country:US
Practice Address - Phone:386-427-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist