Provider Demographics
NPI:1659499184
Name:ACKER RX LLC
Entity Type:Organization
Organization Name:ACKER RX LLC
Other - Org Name:BLOUNTSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:205-429-3351
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35031-0250
Mailing Address - Country:US
Mailing Address - Phone:205-429-3351
Mailing Address - Fax:205-429-3226
Practice Address - Street 1:69005 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLOUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35031
Practice Address - Country:US
Practice Address - Phone:205-429-3351
Practice Address - Fax:205-429-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1130193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0105266OtherNCPDP PROVIDER IDENTIFICATION NUMBER