MEDICARE: AVIE ECKLES PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP451600	PA

General Provider Information

NPI Number	:	1659879526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVIE ECKLES PHARMD

Provider Business Mailing Address
First Line	:	336 WALNUT ST
Second Line	:
City	:	COLUMBIA
State	:	PA
Zip	:	17512-1117
Country	:	US
Telephone Number	:	717-413-5845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 ENTERPRISE RD STE C
Second Line	:
City	:	EAST PETERSBURG
State	:	PA
Zip	:	17520-1604
Country	:	US
Telephone Number	:	717-925-2380
Fax Number	:	717-925-2380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	01/25/2018

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