Provider Demographics
NPI:1265680649
Name:ACKERMAN, MARK BRADLEY (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRADLEY
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E GUN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2109
Mailing Address - Country:US
Mailing Address - Phone:718-654-1685
Mailing Address - Fax:718-515-9118
Practice Address - Street 1:255 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2109
Practice Address - Country:US
Practice Address - Phone:718-654-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist