Healthcare Provider Details

I. General information

NPI: 1629030564
Provider Name (Legal Business Name): MICHAEL TODD ACREE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

15216 S SHADOW CREEK DR
BILOXI MS
39532-8371
US

V. Phone/Fax

Practice location:
  • Phone: 228-377-6582
  • Fax:
Mailing address:
  • Phone: 228-257-9649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202205298
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT09885
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: