Provider Demographics
NPI:1790329019
Name:ECK, MARK WARREN (DPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WARREN
Last Name:ECK
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4020 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-9313
Mailing Address - Country:US
Mailing Address - Phone:560-513-2268
Mailing Address - Fax:580-371-0000
Practice Address - Street 1:4020 ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-9313
Practice Address - Country:US
Practice Address - Phone:560-513-2268
Practice Address - Fax:580-371-0000
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist