Healthcare Provider Details

I. General information

NPI: 1285360545
Provider Name (Legal Business Name): ECKERD CONNECTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E KU SU MEE RD
CANDOR NC
27229-9058
US

IV. Provider business mailing address

500 E KU SU MEE RD
CANDOR NC
27229-9058
US

V. Phone/Fax

Practice location:
  • Phone: 910-974-4183
  • Fax: 910-974-7310
Mailing address:
  • Phone: 910-974-4183
  • Fax: 910-974-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SHATIQUA LEWIS
Title or Position: RN
Credential:
Phone: 910-975-5896