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General NPI Number Information
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NPI Number | 1376040683
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Entity Type | Organization
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Legal Business Name | AUSTIN WELLNESS PHARMACY, LLC
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 6902 AUSTIN ST STE G3
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City | FOREST HILLS
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State | NY
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Zip | 11375-4250
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Country | US
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Telephone | 718-263-6688
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Fax | 718-263-6690
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Provider Business Mailing Address
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Address Line | 6902 AUSTIN ST SUITE G3
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City | FOREST HILLS
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State | NY
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Zip | 11375-4233
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Country | US
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Telephone | 718-263-6688
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Fax | 718-263-6690
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Authorized Official
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Title or Position | OWNER
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Name | STEVE CADDICK
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Credential |
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Telephone | 570-877-2536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 032977
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License Number State | NY
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