Healthcare Provider Details

I. General information

NPI: 1508213455
Provider Name (Legal Business Name): CATLIN LEE GRISHAM-TAKAC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W BRAKER LN
AUSTIN TX
78758-3801
US

IV. Provider business mailing address

9600 GOLF LAKES TRL APT #1004
DALLAS TX
75231-5029
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9300
  • Fax: 512-279-2556
Mailing address:
  • Phone: 979-450-1983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number56848
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: