Provider Demographics
NPI:1174583876
Name:ACKER, OLIVIA DEON (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:DEON
Last Name:ACKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 SUMMIT PL
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-6024
Mailing Address - Country:US
Mailing Address - Phone:205-849-6040
Mailing Address - Fax:
Practice Address - Street 1:69005 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35031-6828
Practice Address - Country:US
Practice Address - Phone:205-429-3351
Practice Address - Fax:205-429-3226
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist