Provider Demographics
NPI:1427536119
Name:ECKERDS RX 106 LLC
Entity Type:Organization
Organization Name:ECKERDS RX 106 LLC
Other - Org Name:ECKERDS PHARMACY 106
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:BACHUBHAI
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARM
Authorized Official - Phone:941-524-6545
Mailing Address - Street 1:120 CIRCLE WAY ST STE 7F
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5222
Mailing Address - Country:US
Mailing Address - Phone:979-341-9811
Mailing Address - Fax:979-341-9822
Practice Address - Street 1:120 CIRCLE WAY ST STE 7F
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5222
Practice Address - Country:US
Practice Address - Phone:979-341-9811
Practice Address - Fax:979-341-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32186332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32186OtherBOARD OF PHARMACY
TX149901Medicaid