Healthcare Provider Details

I. General information

NPI: 1922577832
Provider Name (Legal Business Name): ECKERDS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 66TH ST N
KENNETH CITY FL
33709-4922
US

IV. Provider business mailing address

4404 66TH ST N
KENNETH CITY FL
33709-4922
US

V. Phone/Fax

Practice location:
  • Phone: 727-513-1107
  • Fax: 727-513-1109
Mailing address:
  • Phone: 727-513-1107
  • Fax: 727-513-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BHAVESHKUMAR PATEL
Title or Position: PIC
Credential:
Phone: 813-900-4995