Healthcare Provider Details

I. General information

NPI: 1306175575
Provider Name (Legal Business Name): CHRISTY DIERSCHKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
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 S 1ST ST
AUSTIN TX
78745-3108
US

V. Phone/Fax

Practice location:
  • Phone: 512-441-4747
  • Fax: 512-441-2727
Mailing address:
  • Phone: 512-441-4747
  • Fax: 512-441-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35175
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: