Provider Demographics
NPI:1154435121
Name:ECB PHARMACY INC
Entity type:Organization
Organization Name:ECB PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES R
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-333-4606
Mailing Address - Street 1:1200 WARD AVE
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-2204
Mailing Address - Country:US
Mailing Address - Phone:573-333-4606
Mailing Address - Fax:573-333-2843
Practice Address - Street 1:1200 WARD AVE
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-2204
Practice Address - Country:US
Practice Address - Phone:573-333-4606
Practice Address - Fax:573-333-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100105653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125116OtherPK