Provider Demographics
NPI:1740699891
Name:ACKERMAN, TIMOTHY DONALD (PHARMACIST)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DONALD
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56063-1009
Mailing Address - Country:US
Mailing Address - Phone:507-391-0134
Mailing Address - Fax:507-243-3094
Practice Address - Street 1:128 E BAY DR
Practice Address - Street 2:
Practice Address - City:MADISON LAKE
Practice Address - State:MN
Practice Address - Zip Code:56063-1009
Practice Address - Country:US
Practice Address - Phone:507-391-0134
Practice Address - Fax:507-243-3094
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113000183500000X
AZS014530183500000X
IA15882183500000X
NV16602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist