Healthcare Provider Details

I. General information

NPI: 1952125502
Provider Name (Legal Business Name): ROBERT LOUIS BADEEN JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S CAPITAL OF TEXAS HWY STE F101
WEST LAKE HILLS TX
78746-7075
US

IV. Provider business mailing address

11009 MIDBURY CT
AUSTIN TX
78748-3931
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-0490
  • Fax:
Mailing address:
  • Phone: 512-934-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number8873
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: