Provider Demographics
NPI:1487935326
Name:ECKSTEIN, TERRENCE J (RPH)
Entity type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:J
Last Name:ECKSTEIN
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 1:1212 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-5400
Mailing Address - Country:US
Mailing Address - Phone:630-820-4098
Mailing Address - Fax:630-820-5393
Practice Address - Street 1:1212 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-5400
Practice Address - Country:US
Practice Address - Phone:630-820-4098
Practice Address - Fax:630-820-5393
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-036250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist