Provider Demographics
NPI:1629668702
Name:ECKERT, JAMES DAVID
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:ECKERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25004 S MEGHAN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-4290
Mailing Address - Country:US
Mailing Address - Phone:816-810-5989
Mailing Address - Fax:660-679-5003
Practice Address - Street 1:913 W FORT SCOTT ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730
Practice Address - Country:US
Practice Address - Phone:660-679-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty