Provider Demographics
NPI:1730723685
Name:ECKERDS RX 107 LLC
Entity type:Organization
Organization Name:ECKERDS RX 107 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-524-6545
Mailing Address - Street 1:710 N BREVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-8778
Mailing Address - Country:US
Mailing Address - Phone:863-485-4150
Mailing Address - Fax:863-485-4151
Practice Address - Street 1:710 N BREVARD AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8778
Practice Address - Country:US
Practice Address - Phone:863-485-4150
Practice Address - Fax:863-485-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy