Healthcare Provider Details

I. General information

NPI: 1811003072
Provider Name (Legal Business Name): KELANI CONDON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W. 49TH ST. PHARMACY BRANCH
AUSTIN TX
78756
US

IV. Provider business mailing address

1100 W. 49TH ST. PHARMACY BRANCH
AUSTIN TX
78756
US

V. Phone/Fax

Practice location:
  • Phone: 512-776-7500
  • Fax:
Mailing address:
  • Phone: 512-776-7500
  • Fax: 512-776-7489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43385T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43385
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: