NPIMap

Organization Active NPI

Hackley Pharmacy Norton Shores

  • Community/Retail Pharmacy
  • Muskegon, MI
National Provider Identifier
1487793436
Registry record updated Feb 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301008544 Issued in MI
Legal business name
HACKLEY PHARMACY NORTON SHORES
Practice address
3535 Park St
Ste 104
Muskegon, MI 49444-3736
Phone
(231) 739-9302
Fax
(231) 728-1604
NPI assigned
Feb 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2008

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

Authorized official

Name
Carlton Bosse
Title
Director of Pharmacy
Phone
(231) 728-5974

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301008544 MI Primary
Compounding Pharmacy 3336C0004X
Institutional Pharmacy 3336I0012X

Addresses

Primary practice location

3535 Park St
Ste 104
Muskegon, MI 49444-3736

Mailing address

3535 Park St
Ste 104
Muskegon, MI 49444-3736

Other identifiers 3

IdentifierTypeStateIssuer
2369165OtherOTHER ID NUMBER
2369165MedicaidMI
2369165OtherOTHER ID NUMBER-COMMERCIAL NUMBER

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.

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203638400000",
    "number": "1487793436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 PARK ST",
            "address_2": "STE 104",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494443736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 PARK ST",
            "address_2": "STE 104",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494443736",
            "telephone_number": "231-739-9302",
            "fax_number": "231-728-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKLEY PHARMACY NORTON SHORES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2008-02-22",
        "status": "A",
        "authorized_official_last_name": "BOSSE",
        "authorized_official_first_name": "CARLTON",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "231-728-5974"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301008544",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2369165",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2369165",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2369165",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Feb 22, 2008; 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.