Provider Demographics
NPI:1043840770
Name:ECKERSLEY, JOHN (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ECKERSLEY
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:PO BOX 5190
Mailing Address - Street 2:
Mailing Address - City:WEST WENDOVER
Mailing Address - State:NV
Mailing Address - Zip Code:89883-5190
Mailing Address - Country:US
Mailing Address - Phone:775-664-3197
Mailing Address - Fax:775-664-3207
Practice Address - Street 1:1855 WEST WENDOVER BLVD
Practice Address - Street 2:
Practice Address - City:WEST WENDOVER
Practice Address - State:NV
Practice Address - Zip Code:89883
Practice Address - Country:US
Practice Address - Phone:775-664-3197
Practice Address - Fax:775-664-3207
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV176281835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist