Healthcare Provider Details

I. General information

NPI: 1114040391
Provider Name (Legal Business Name): PEOPLES PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 WESTBANK DR
AUSTIN TX
78746-4454
US

IV. Provider business mailing address

4201 WESTBANK DR
AUSTIN TX
78746-4454
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-8877
  • Fax: 512-327-0329
Mailing address:
  • Phone: 512-327-8877
  • Fax: 512-327-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05895
License Number StateTX

VIII. Authorized Official

Name: DONNA NICOLOFF
Title or Position: ACCOUNTS RECEIVABLE
Credential:
Phone: 512-447-1799