Provider Demographics
NPI:1578794657
Name:ECKLUND, DOUGLAS KEITH (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:KEITH
Last Name:ECKLUND
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 1:921 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1826
Mailing Address - Country:US
Mailing Address - Phone:941-539-6841
Mailing Address - Fax:
Practice Address - Street 1:921 OXFORD DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1826
Practice Address - Country:US
Practice Address - Phone:941-539-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist