NPIMap

Organization Active NPI

Hackley Professional Pharmacy, Inc

  • Specialty Pharmacy
  • Muskegon, MI
National Provider Identifier
1013626639
Registry record updated Nov 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Specialty PharmacyTaxonomy code 3336S0011X
Legal business name
HACKLEY PROFESSIONAL PHARMACY, INC
Practice address
1675 Leahy St Ste 111
Muskegon, MI 49442-5538
Phone
(231) 672-7822
Fax
(231) 672-8425
NPI assigned
Nov 22, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tara Zdybel, PHARMDNPI 1821716796
Title
Pharmacy Manager
Phone
(231) 672-4899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialty Pharmacy 3336S0011X Primary

Addresses

Primary practice location

1675 Leahy St Ste 111
Muskegon, MI 49442-5538

Mailing address

1675 Leahy St Ste 111
Muskegon, MI 49442-5538
Phone (231) 672-7822

Other identifiers 1

IdentifierTypeStateIssuer
1497896351MedicaidMI

Other names 1

  • Trinity Health Pharmacy - Hackley Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hackley Pharmacy Norton Shores10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1675 Leahy St
Ste 111
Muskegon, MI 49442
Phone (231) 672-7822

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1013626639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 LEAHY ST STE 111",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425538",
            "telephone_number": "231-672-7822",
            "fax_number": "231-672-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 LEAHY ST STE 111",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425538",
            "telephone_number": "231-672-7822",
            "fax_number": "231-672-8425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKLEY PROFESSIONAL PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-22",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A",
        "authorized_official_last_name": "ZDYBEL",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "231-672-4899",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497896351",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Health Pharmacy - Hackley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.