Healthcare Provider Details

I. General information

NPI: 1558474734
Provider Name (Legal Business Name): 38TH STREET PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST STE C3
AUSTIN TX
78705-1126
US

IV. Provider business mailing address

711 W 38TH ST STE C3
AUSTIN TX
78705-1126
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-3784
  • Fax: 512-458-1882
Mailing address:
  • Phone: 512-458-3784
  • Fax: 512-458-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13873
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0812860001
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY WAYNE WARNKEN
Title or Position: PRESIDENT
Credential: RPH
Phone: 512-458-3784