Healthcare Provider Details

I. General information

NPI: 1578433165
Provider Name (Legal Business Name): REBECCA ECKSTROM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 NW JOHN JONES DR
BURLESON TX
76028-5154
US

IV. Provider business mailing address

165 NW JOHN JONES DR
BURLESON TX
76028-5154
US

V. Phone/Fax

Practice location:
  • Phone: 817-447-3213
  • Fax:
Mailing address:
  • Phone: 817-447-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: