Provider Demographics
NPI:1689007585
Name:ACKER, JUSTIN CHRISTOPHER (PHARMD RPH)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CHRISTOPHER
Last Name:ACKER
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 1:2803 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:MATTYDALE
Mailing Address - State:NY
Mailing Address - Zip Code:13211-1003
Mailing Address - Country:US
Mailing Address - Phone:315-455-7401
Mailing Address - Fax:315-455-7529
Practice Address - Street 1:2803 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:MATTYDALE
Practice Address - State:NY
Practice Address - Zip Code:13211-1003
Practice Address - Country:US
Practice Address - Phone:315-455-7401
Practice Address - Fax:315-455-7529
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist