Healthcare Provider Details

I. General information

NPI: 1649346743
Provider Name (Legal Business Name): AUSTIN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S MILWAUKEE AVE SUITE 109
WHEELING IL
60090-5076
US

IV. Provider business mailing address

307 S MILWAUKEE AVE SUITE 109
WHEELING IL
60090-5076
US

V. Phone/Fax

Practice location:
  • Phone: 847-229-5477
  • Fax: 847-229-8448
Mailing address:
  • Phone: 847-229-5477
  • Fax: 847-229-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054014320
License Number StateIL

VIII. Authorized Official

Name: ARTHUR MAZZENGA
Title or Position: OWNER
Credential: RPH
Phone: 773-685-2277