=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336759505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ECKERDS RX 108 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2020
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17510 N US HIGHWAY 41
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33549-4571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-499-9266
-----------------------------------------------------
Fax | 813-499-9277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17510 N US HIGHWAY 41 STE 102
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33549-4571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-499-9266
-----------------------------------------------------
Fax | 813-499-9277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VIKRAM RAO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-538-7122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------