Healthcare Provider Details

I. General information

NPI: 1891390381
Provider Name (Legal Business Name): NEELA SADRUDDIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 CENTRE CREEK DR
AUSTIN TX
78754-5112
US

IV. Provider business mailing address

10409 CAMBRIA COAST RUN
AUSTIN TX
78717-4992
US

V. Phone/Fax

Practice location:
  • Phone: 512-579-0184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61531
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: