Provider Demographics
NPI:1871909838
Name:ACKERMAN, JEFFREY ALAN (PHARM D)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3544 MERIDIAN CROSSINGS
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6025
Mailing Address - Country:US
Mailing Address - Phone:517-381-7472
Mailing Address - Fax:
Practice Address - Street 1:4236 ISELER RD
Practice Address - Street 2:
Practice Address - City:FILION
Practice Address - State:MI
Practice Address - Zip Code:48432-9719
Practice Address - Country:US
Practice Address - Phone:989-284-4639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist