Provider Demographics
NPI:1487329546
Name:ECKENBERGER, DAVID WALTER (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WALTER
Last Name:ECKENBERGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 WILLOW GLEN RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2230
Mailing Address - Country:US
Mailing Address - Phone:804-356-3923
Mailing Address - Fax:
Practice Address - Street 1:9650 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4115
Practice Address - Country:US
Practice Address - Phone:804-273-9276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202008084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist