Healthcare Provider Details

I. General information

NPI: 1598337537
Provider Name (Legal Business Name): AUSTIN CAIN CPHT, CSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2021
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N HILLSIDE ST
WICHITA KS
67214-4976
US

IV. Provider business mailing address

404 N KEENE ST
COLUMBIA MO
65201-6626
US

V. Phone/Fax

Practice location:
  • Phone: 316-962-2000
  • Fax:
Mailing address:
  • Phone: 573-875-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number14-100565
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: