Provider Demographics
NPI:1780960070
Name:ECKLUND, RICHARD ALLEN
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:ECKLUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 M L KING AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4346
Mailing Address - Country:US
Mailing Address - Phone:904-347-9900
Mailing Address - Fax:
Practice Address - Street 1:6800 SOUTHPOINT PKWY STE 980
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8203
Practice Address - Country:US
Practice Address - Phone:904-347-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist