Healthcare Provider Details

I. General information

NPI: 1114247756
Provider Name (Legal Business Name): JUDITH DORETEA ACKERMANN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 06/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23455-5523
US

IV. Provider business mailing address

1075 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23455-5523
US

V. Phone/Fax

Practice location:
  • Phone: 757-464-2565
  • Fax:
Mailing address:
  • Phone: 757-464-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202209188
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: