Healthcare Provider Details

I. General information

NPI: 1336759505
Provider Name (Legal Business Name): ECKERDS RX 108 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17510 N US HIGHWAY 41
LUTZ FL
33549-4571
US

IV. Provider business mailing address

17510 N US HIGHWAY 41 STE 102
LUTZ FL
33549-4571
US

V. Phone/Fax

Practice location:
  • Phone: 813-499-9266
  • Fax: 813-499-9277
Mailing address:
  • Phone: 813-499-9266
  • Fax: 813-499-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VIKRAM RAO
Title or Position: PRESIDENT
Credential:
Phone: 941-538-7122