Provider Demographics
NPI:1750688966
Name:ECKLUND, SARA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:ECKLUND
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 1:625 W PERSHING RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1632
Mailing Address - Country:US
Mailing Address - Phone:217-875-2751
Mailing Address - Fax:
Practice Address - Street 1:625 W PERSHING RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1632
Practice Address - Country:US
Practice Address - Phone:217-875-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5220183500000X
IL051.292881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist