Healthcare Provider Details

I. General information

NPI: 1629112412
Provider Name (Legal Business Name): EMMA ELIZABETH WASKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 METRIC BLVD BLDG H VENDOR DRUG PROGRAM H 630
AUSTIN TX
78758
US

IV. Provider business mailing address

9800 KENDAL DR
AUSTIN TX
78753
US

V. Phone/Fax

Practice location:
  • Phone: 512-491-1155
  • Fax: 512-491-1961
Mailing address:
  • Phone: 512-837-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number115944
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: