Healthcare Provider Details

I. General information

NPI: 1467512434
Provider Name (Legal Business Name): HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E M L KING BLVD
AUSTIN TX
78702
US

IV. Provider business mailing address

2115 E M L KING BLVD
AUSTIN TX
78702
US

V. Phone/Fax

Practice location:
  • Phone: 512-476-7338
  • Fax: 512-476-7341
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3355
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: O HOUSTON
Title or Position: OWNER
Credential:
Phone: 517-476-7338