Timothy Donald Ackerman, PHARMACIST

Primary specialty

PharmacistTaxonomy code 183500000X

License

113000 Issued in MN

Practice address

128 E Bay Dr
Madison Lake, MN 56063-1009

Phone

(507) 391-0134

Fax

(507) 243-3094

NPI assigned

Aug 2, 2014

Last updated

Nov 13, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415836800000",
    "number": "1740699891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 E BAY DR",
            "city": "MADISON LAKE",
            "state": "MN",
            "postal_code": "560631009",
            "telephone_number": "507-391-0134",
            "fax_number": "507-243-3094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 E BAY DR",
            "city": "MADISON LAKE",
            "state": "MN",
            "postal_code": "560631009",
            "telephone_number": "507-391-0134",
            "fax_number": "507-243-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACKERMAN",
        "first_name": "TIMOTHY",
        "middle_name": "DONALD",
        "credential": "PHARMACIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-02",
        "last_updated": "2014-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "113000",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S014530",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "15882",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NV",
            "license": "16602",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Madison Lake, MN
• Providers in Madison Lake, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.