Provider Demographics
NPI:1780410308
Name:EECKMAN, ANNELISE (PHARMD)
Entity type:Individual
Prefix:
First Name:ANNELISE
Middle Name:
Last Name:EECKMAN
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 1:7139 WURZBACH RD APT 1206
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1798
Mailing Address - Country:US
Mailing Address - Phone:510-345-7425
Mailing Address - Fax:
Practice Address - Street 1:7139 WURZBACH RD APT 1206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1798
Practice Address - Country:US
Practice Address - Phone:510-345-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42458390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program