Provider Demographics
NPI:1447535679
Name:ECKART, LAURA NICOLE (PHAMD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:ECKART
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:TIMBERLAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11541 FOREST HILL CIR
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-8639
Mailing Address - Country:US
Mailing Address - Phone:812-736-3495
Mailing Address - Fax:
Practice Address - Street 1:934-940 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-283-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023254A183500000X
KY014681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist