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 1:160 CAMBRIDGEPARK DR UNIT 334
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2464
Mailing Address - Country:US
Mailing Address - Phone:510-345-7425
Mailing Address - Fax:
Practice Address - Street 1:160 CAMBRIDGEPARK DR UNIT 334
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2464
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:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH1002691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist