Provider Demographics
NPI:1326568676
Name:ACKERMAN, COREY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15552 GRATIOT RD
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:MI
Mailing Address - Zip Code:48626-8458
Mailing Address - Country:US
Mailing Address - Phone:989-372-4416
Mailing Address - Fax:
Practice Address - Street 1:15552 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-8458
Practice Address - Country:US
Practice Address - Phone:989-372-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist