Provider Demographics
NPI:1447387113
Name:ECK DRUG CO INC
Entity Type:Organization
Organization Name:ECK DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-229-1141
Mailing Address - Street 1:322 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEALDTON
Mailing Address - State:OK
Mailing Address - Zip Code:73438-2118
Mailing Address - Country:US
Mailing Address - Phone:580-229-1141
Mailing Address - Fax:580-229-1142
Practice Address - Street 1:322 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438-2118
Practice Address - Country:US
Practice Address - Phone:580-229-1141
Practice Address - Fax:580-229-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12 3873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1073980001Medicare ID - Type UnspecifiedMEDICARE PART B