=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205532967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUSTIN BERNARD ZYDEL PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2023
-----------------------------------------------------
Last Update Date | 02/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4155 EWALT RD
-----------------------------------------------------
City | GIBSONIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15044-7513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-449-8080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 CRISSWELL RD
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16002-8638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP457458
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------