Organization
HACKLEY PHARMACY NORTON SHORES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLTON BOSSE (DIRECTOR OF PHARMACY)
(231) 728-5974
Entity
Organization
Contact information
Practice address
3535 PARK ST, STE 104, MUSKEGON, MI 49444-3736
(231) 739-9302
(231) 728-1604
Mailing address
3535 PARK ST, STE 104, MUSKEGON, MI 49444-3736
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301008544
MI
3336C0004X
Compounding Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2369165
OTHER ID NUMBER
—
05
—
2369165
—
MI
Enumeration date
02/06/2007
Last updated
02/22/2008
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