Provider Demographics
NPI:1932290517
Name:ECKERT DRUG
Entity Type:Organization
Organization Name:ECKERT DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-342-2388
Mailing Address - Street 1:11509 S FORTUNA RD
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-7857
Mailing Address - Country:US
Mailing Address - Phone:928-342-2388
Mailing Address - Fax:928-342-2389
Practice Address - Street 1:11509 S FORTUNA RD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7857
Practice Address - Country:US
Practice Address - Phone:928-342-2388
Practice Address - Fax:928-342-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0312897OtherNABP