Healthcare Provider Details

I. General information

NPI: 1336312875
Provider Name (Legal Business Name): MICHAEL PHILIP GAINES PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12407 N. MOPAC EXPRESSWAY
AUSTIN TX
78758
US

IV. Provider business mailing address

12407 N. MOPAC EXPRESSWAY
AUSTIN TX
78758
US

V. Phone/Fax

Practice location:
  • Phone: 512-339-6644
  • Fax: 512-832-9128
Mailing address:
  • Phone: 512-339-6644
  • Fax: 512-832-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number34240
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: