Healthcare Provider Details

I. General information

NPI: 1760623490
Provider Name (Legal Business Name): MICHELLE RENEE SEYBERT ECKART PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

9125 SARGENT CREEK DR
INDIANAPOLIS IN
46256-1374
US

V. Phone/Fax

Practice location:
  • Phone: 317-429-6179
  • Fax:
Mailing address:
  • Phone: 317-429-6179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1706
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26020476A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: