Provider Demographics
NPI:1518454552
Name:ECKENROD, JODIE
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:ECKENROD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 BIG MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1601
Mailing Address - Country:US
Mailing Address - Phone:412-257-9797
Mailing Address - Fax:
Practice Address - Street 1:955 RIVERMONT DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15207-1347
Practice Address - Country:US
Practice Address - Phone:412-422-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041901L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist