Healthcare Provider Details

I. General information

NPI: 1154435121
Provider Name (Legal Business Name): ECB PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WARD AVE
CARUTHERSVILLE MO
63830-2204
US

IV. Provider business mailing address

1200 WARD AVE
CARUTHERSVILLE MO
63830-2204
US

V. Phone/Fax

Practice location:
  • Phone: 573-333-4606
  • Fax: 573-333-2843
Mailing address:
  • Phone: 573-333-4606
  • Fax: 573-333-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2010010565
License Number StateMO

VIII. Authorized Official

Name: JAMES R BRANDS
Title or Position: PRESIDENT
Credential:
Phone: 573-333-4606