Provider Demographics
NPI:1881982718
Name:HACKLEMAN, STEVEN KENT (PHARMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:KENT
Last Name:HACKLEMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 AKIN RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1675
Mailing Address - Country:US
Mailing Address - Phone:817-723-3436
Mailing Address - Fax:
Practice Address - Street 1:102 RICHMOND RANCH RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1081
Practice Address - Country:US
Practice Address - Phone:903-223-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist