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General NPI Number Information
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NPI Number | 1033816756
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Entity Type | Individual
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Provider Name | ALIVIA DAUGHERTY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 2501 W WILLIAM CANNON DR STE 203
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City | AUSTIN
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State | TX
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Zip | 78745-5255
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Country | US
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Telephone | 512-707-2300
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Fax | 512-707-2378
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Provider Business Mailing Address
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Address Line | 3014 W WILLIAM CANNON DR APT 324
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City | AUSTIN
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State | TX
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Zip | 78745-5137
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Country | US
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Telephone | 765-215-5776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26029277A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 68741
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License Number State | TX
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