Provider Demographics
NPI:1194326009
Name:ECKERLE, JEFFERY JAMES
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:JAMES
Last Name:ECKERLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 BELLGRADE DR
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-4796
Mailing Address - Country:US
Mailing Address - Phone:812-295-6830
Mailing Address - Fax:
Practice Address - Street 1:2251 E STATE HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9498
Practice Address - Country:US
Practice Address - Phone:812-847-8648
Practice Address - Fax:812-847-4353
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019727A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist