Provider Demographics
NPI:1124391982
Name:ECKLEY, ROLLAND GENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROLLAND
Middle Name:GENE
Last Name:ECKLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13329 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9530
Mailing Address - Country:US
Mailing Address - Phone:419-826-2348
Mailing Address - Fax:
Practice Address - Street 1:13329 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-9530
Practice Address - Country:US
Practice Address - Phone:419-826-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10257183500000X
GARPH011300183500000X
MI5302022037183500000X
OH03111068183500000X
HIPH-1365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist