Provider Demographics
NPI:1730688946
Name:HACKING, DOUGLAS RAY
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:RAY
Last Name:HACKING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1943
Mailing Address - Country:US
Mailing Address - Phone:405-755-2892
Mailing Address - Fax:405-751-4419
Practice Address - Street 1:12301 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1943
Practice Address - Country:US
Practice Address - Phone:405-755-2892
Practice Address - Fax:405-751-4419
Is Sole Proprietor?:No
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist