Healthcare Provider Details

I. General information

NPI: 1871787176
Provider Name (Legal Business Name): 38TH STREET PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST STE C3
AUSTIN TX
78705-1126
US

IV. Provider business mailing address

711 W 38TH ST STE C3
AUSTIN TX
78705-1126
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-3784
  • Fax: 512-458-1882
Mailing address:
  • Phone: 512-458-3784
  • Fax: 512-458-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0812860001
License Number StateTX

VIII. Authorized Official

Name: MR. JEFFREY WARNKEN
Title or Position: PRESIDENT
Credential:
Phone: 512-458-3784