Healthcare Provider Details

I. General information

NPI: 1083077929
Provider Name (Legal Business Name): TIMOTHY SCOTT ACKERMAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 12/28/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 E MAIN ST
LITITZ PA
17543-0900
US

IV. Provider business mailing address

74 E MAIN ST
LITITZ PA
17543-0900
US

V. Phone/Fax

Practice location:
  • Phone: 610-553-6036
  • Fax:
Mailing address:
  • Phone: 610-553-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP-035839-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27704
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: