Healthcare Provider Details

I. General information

NPI: 1407487770
Provider Name (Legal Business Name): ALLISON NOELLE VENCILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 UNIVERSITY AVE
AUSTIN TX
78712-1112
US

IV. Provider business mailing address

2409 UNIVERSITY AVE
AUSTIN TX
78712-1112
US

V. Phone/Fax

Practice location:
  • Phone: 512-560-9990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number270427
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number39413
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: