Provider Demographics
NPI:1659879526
Name:ECKLES, AVIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AVIE
Middle Name:
Last Name:ECKLES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-1117
Mailing Address - Country:US
Mailing Address - Phone:717-413-5845
Mailing Address - Fax:
Practice Address - Street 1:1110 ENTERPRISE RD STE C
Practice Address - Street 2:
Practice Address - City:EAST PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520-1604
Practice Address - Country:US
Practice Address - Phone:717-925-2380
Practice Address - Fax:717-925-2380
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist