Organization
HACKLEY PHARMACY-WOLF LAKE
Active
Other names
HACKLEY PHARMACY- WOLF LAKE
Organization subpart
No
Provider details
NPI number
Authorized official
KIM DEBRUIN RPH (RETAIL PHARMACY MANAGER)
(231) 728-4046
Entity
Organization
Contact information
Practice address
5483 E APPLE AVE, MUSKEGON, MI 49442-3070
(231) 788-4087
(231) 788-3090
Mailing address
5483 E APPLE AVE, MUSKEGON, MI 49442-3070
(231) 788-4087
(231) 788-3090
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301005301
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2040771
PK
—
05
—
2643897
—
MI
Enumeration date
02/12/2007
Last updated
07/03/2014
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