Provider Demographics
NPI:1881297620
Name:HACKETT, CHERYL DENISE (RPH)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENISE
Last Name:HACKETT
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 1:33 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2705
Mailing Address - Country:US
Mailing Address - Phone:802-310-2457
Mailing Address - Fax:
Practice Address - Street 1:78 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8920
Practice Address - Country:US
Practice Address - Phone:802-878-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0003326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist