=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285084467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A.E. PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2016
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 S PLEASANT VALLEY ROAD SUITE 201
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78744-2911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-537-3205
-----------------------------------------------------
Fax | 512-677-6267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4500 S PLEASANT VALLEY RD STE 201
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78744-2911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-745-5725
-----------------------------------------------------
Fax | 603-935-9108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | TANVI JAYANTI PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 855-745-5725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 30875
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------