Provider Demographics
NPI:1750724597
Name:ECKHART, ROBERT (PHARM D)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ECKHART
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:ID
Mailing Address - Zip Code:83850-0400
Mailing Address - Country:US
Mailing Address - Phone:208-682-3920
Mailing Address - Fax:208-682-3939
Practice Address - Street 1:504 N. DIVISION ST
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:ID
Practice Address - Zip Code:83850
Practice Address - Country:US
Practice Address - Phone:208-682-3920
Practice Address - Fax:208-682-3939
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5801183500000X
IDCS10374183500000X
WAPH 00055425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP5801OtherIDAHO PHARMACIST LICENSE
WAPH 00055425OtherWASHINGTON PHARMACIST LICENSE
IDCS10374OtherPHARMACIST CONTROLLED SUBSTANCE LICENSE