Healthcare Provider Details

I. General information

NPI: 1942466016
Provider Name (Legal Business Name): BETSY CARLISLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 15TH ST DEPT OF PHARMACY
AUSTIN TX
78701-1930
US

IV. Provider business mailing address

601 E 15TH ST DEPT OF PHARMACY
AUSTIN TX
78701-1930
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-7000
  • Fax: 512-324-8225
Mailing address:
  • Phone: 512-324-7000
  • Fax: 512-324-8225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number27081
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: