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General NPI Number Information
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NPI Number | 1407455041
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Entity Type | Individual
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Provider Name | ANDREA AUSTIN
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Gender | Female
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Dates
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Enumeration Date | 10/24/2020
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 1952 W DALLAS AVE
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City | SELMA
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State | AL
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Zip | 36701-7027
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Country | US
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Telephone | 334-872-7211
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Fax |
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Provider Business Mailing Address
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Address Line | 404 DARLINGTON CIR
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City | DOTHAN
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State | AL
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Zip | 36301-4652
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Country | US
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Telephone | 334-794-0393
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 20841
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License Number State | AL
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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 | 20841
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License Number State | AL
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