Provider Demographics
NPI:1265038673
Name:ECKSTEIN, STEPHEN BLAINE (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BLAINE
Last Name:ECKSTEIN
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 1:2024 MT WELCOME
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-719-7283
Mailing Address - Fax:340-719-7284
Practice Address - Street 1:2024 MT WELCOME
Practice Address - Street 2:SUITE 11
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-719-7283
Practice Address - Fax:340-719-7284
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0277511835P0018X
VI1811835P0018X
VA0202007469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty