Healthcare Provider Details

I. General information

NPI: 1093814287
Provider Name (Legal Business Name): ECKERD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 AUGUSTA ST STE 102
GREENVILLE SC
29605-6500
US

IV. Provider business mailing address

200 NEWBERRY COMMONS
ETTERS PA
17319-9363
US

V. Phone/Fax

Practice location:
  • Phone: 864-233-6689
  • Fax: 864-271-6551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50007872
License Number StateSC

VIII. Authorized Official

Name: JENNIFER ZOREK
Title or Position: MANAGER ONLINE ADJUDICATION
Credential:
Phone: 717-975-5937