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General NPI Number Information
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NPI Number | 1790117539
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Entity Type | Individual
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Provider Name | JERAD DALE BINSTOCK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2013
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Last Update Date | 11/16/2014
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Provider Practice Location Address
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Address Line | 13201 RANCH ROAD 620 N
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City | AUSTIN
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State | TX
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Zip | 78717-1011
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Country | US
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Telephone | 512-335-5275
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Fax |
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Provider Business Mailing Address
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Address Line | 901 HIDDEN VALLEY DR APT 17204
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City | ROUND ROCK
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State | TX
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Zip | 78665-1394
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Country | US
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Telephone | 701-260-9705
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 53499
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License Number State | TX
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