Provider Demographics
NPI:1326821364
Name:RETTKER, ALEXANDER JAMES (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JAMES
Last Name:RETTKER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N KARWICK RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-2191
Mailing Address - Country:US
Mailing Address - Phone:219-872-6811
Mailing Address - Fax:
Practice Address - Street 1:901 N KARWICK RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-2191
Practice Address - Country:US
Practice Address - Phone:219-872-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030439A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist