Provider Demographics
NPI:1477720746
Name:ACKER, RENE L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RENE
Middle Name:L
Last Name:ACKER
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 1:354 MORAN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3435
Mailing Address - Country:US
Mailing Address - Phone:810-357-2765
Mailing Address - Fax:
Practice Address - Street 1:777 WOODWARD AVE
Practice Address - Street 2:600
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3536
Practice Address - Country:US
Practice Address - Phone:810-357-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist