Provider Demographics
NPI:1649683111
Name:ACKER, ANNETTE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:ACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 BELTWAY PL
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5262
Mailing Address - Country:US
Mailing Address - Phone:682-323-5959
Mailing Address - Fax:325-646-8275
Practice Address - Street 1:4360 BELTWAY PL
Practice Address - Street 2:SUITE 260
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5262
Practice Address - Country:US
Practice Address - Phone:682-323-5959
Practice Address - Fax:325-646-8275
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist