Provider Demographics
NPI:1699651570
Name:ECKARDT, OWEN (PHARMD)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:ECKARDT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 N CLARK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ODESSA
Mailing Address - State:MI
Mailing Address - Zip Code:48849-9450
Mailing Address - Country:US
Mailing Address - Phone:616-337-2458
Mailing Address - Fax:
Practice Address - Street 1:126 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1812
Practice Address - Country:US
Practice Address - Phone:269-908-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302417882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist