Provider Demographics
NPI:1700030442
Name:ECKLES, AUDREY MELISSA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:MELISSA
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 1:4467 N HENRY BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3656
Mailing Address - Country:US
Mailing Address - Phone:770-474-0704
Mailing Address - Fax:770-507-4121
Practice Address - Street 1:4467 N HENRY BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3656
Practice Address - Country:US
Practice Address - Phone:770-474-0704
Practice Address - Fax:770-507-4121
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist