Provider Demographics
NPI:1972636066
Name:BROOKS ECKERD PHARMACY
Entity Type:Organization
Organization Name:BROOKS ECKERD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRASHANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHPANDE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-491-5048
Mailing Address - Street 1:1821 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6451
Mailing Address - Country:US
Mailing Address - Phone:919-491-5048
Mailing Address - Fax:
Practice Address - Street 1:101 W WOODCROFT PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9471
Practice Address - Country:US
Practice Address - Phone:919-484-8817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty