NPIMap

Organization Active NPI

Hackley Professional Pharmacy, Inc

Doing business as Mercy Health Pharmacy- Lakes

  • Community/Retail Pharmacy
  • Norton Shores, MI
National Provider Identifier
1962417576
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301008308 Issued in MI
Legal business name
HACKLEY PROFESSIONAL PHARMACY, INC
Doing business as
Mercy Health Pharmacy- Lakes
Trinity Health Pharmacy - Lakes Village
Practice address
6401 Prairie St Ste 1100
Norton Shores, MI 49444-7839
Phone
(231) 672-7821
Fax
(231) 727-7971
NPI assigned
Jul 30, 2006
Last updated
Nov 10, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
HACKLEY PROFESSIONAL PHARMACY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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

Authorized official

Name
Kristi Karole Nagengast
Title
VP of Finance
Phone
(231) 728-1950

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 5301008308 MI Primary

Addresses

Primary practice location

6401 Prairie St Ste 1100
Norton Shores, MI 49444-7839

Mailing address

6401 Prairie St Ste 1100
Norton Shores, MI 49444-7839
Phone (231) 672-7821

Other identifiers 2

IdentifierTypeStateIssuer
2368024MedicaidMI
2042118OtherPK

Other names 2

  • MERCY HEALTH PHARMACY- LAKES Doing business as
  • Trinity Health Pharmacy - Lakes Village Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hackley Healthcare Equipment5 organizations share this tax ID, including this one
Part of
Hackley Pharmacy Muskegon HTS

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1962417576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6401 PRAIRIE ST STE 1100",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494447839",
            "telephone_number": "231-672-7821",
            "fax_number": "231-727-7971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 PRAIRIE ST STE 1100",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494447839",
            "telephone_number": "231-672-7821",
            "fax_number": "231-727-7971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKLEY PROFESSIONAL PHARMACY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HACKLEY PROFESSIONAL PHARMACY, INC",
        "enumeration_date": "2006-07-30",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "NAGENGAST",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "KAROLE",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "231-728-1950"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301008308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2368024",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2042118",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY HEALTH PHARMACY- LAKES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Trinity Health Pharmacy - Lakes Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norton Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.