Healthcare Provider Details

I. General information

NPI: 1972636066
Provider Name (Legal Business Name): BROOKS ECKERD PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W WOODCROFT PKWY
DURHAM NC
27713-9471
US

IV. Provider business mailing address

1821 COUNTRY LN
DURHAM NC
27713-6451
US

V. Phone/Fax

Practice location:
  • Phone: 919-484-8817
  • Fax:
Mailing address:
  • Phone: 919-491-5048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17552
License Number StateNC

VIII. Authorized Official

Name: MR. PRASHANTH DESHPANDE
Title or Position: PHARMACIST MANAGER
Credential: RPH
Phone: 919-491-5048