Provider Demographics
NPI:1316416977
Name:ACKERMAN, ANGELA RISSER (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RISSER
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10413 WORTHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9565
Mailing Address - Country:US
Mailing Address - Phone:317-502-1449
Mailing Address - Fax:
Practice Address - Street 1:3408 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4608
Practice Address - Country:US
Practice Address - Phone:502-912-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018420A183500000X
KY017047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist