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NPI Code Detail

MEDICARE: CLINTON GERARD VANACKER

MEDICARE: CLINTON GERARD VANACKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistS011553AZ

General Provider Information

NPI Number : 1851621049
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLINTON GERARD VANACKER
Provider Business Mailing Address
First Line : 3402 N CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2202
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3402 N CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2202
Country : US
Telephone Number : 602-265-4781
Fax Number : 602-265-1447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2010
Last Update Date : 01/11/2010

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Directions to “ CLINTON GERARD VANACKER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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