Provider Demographics
NPI:1245355502
Name:ACKERHALT, ROBERT EDWARD (PHD, RPH)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:ACKERHALT
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HERITAGE RD E
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2307
Mailing Address - Country:US
Mailing Address - Phone:716-688-1262
Mailing Address - Fax:716-810-0687
Practice Address - Street 1:840 AERO DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1451
Practice Address - Country:US
Practice Address - Phone:716-810-0688
Practice Address - Fax:716-810-0687
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0346171835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear