Healthcare Provider Details

I. General information

NPI: 1184930307
Provider Name (Legal Business Name): PAYAL PATWA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 S 1ST ST
AUSTIN TX
78745-3108
US

IV. Provider business mailing address

5600 SOUTH 1ST STREET
AUSTIN TX
78745-7970
US

V. Phone/Fax

Practice location:
  • Phone: 512-441-4747
  • Fax:
Mailing address:
  • Phone: 512-441-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48879
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: