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General NPI Number Information
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NPI Number | 1154790376
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Entity Type | Organization
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Legal Business Name | EAST AUSTIN MEDICINE SHOP
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 1909 E 38TH 1/2 ST STE C2
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City | AUSTIN
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State | TX
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Zip | 78723-5749
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Country | US
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Telephone | 512-643-0999
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Fax | 512-643-4074
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Provider Business Mailing Address
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Address Line | 1909 E 38TH 1/2 ST STE C2
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City | AUSTIN
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State | TX
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Zip | 78723-5749
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Country | US
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Telephone | 512-643-0999
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Fax | 512-643-4074
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Authorized Official
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Title or Position | PIC
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Name | CHRISTOPHER JOHN PERLING
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Credential | RPH
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Telephone | 512-643-0999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 30135
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License Number State | TX
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