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General NPI Number Information
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NPI Number | 1801132873
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Entity Type | Organization
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Legal Business Name | SOUTH AUSTIN PHARMACY LLC
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 4203A JAMES CASEY ST
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City | AUSTIN
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State | TX
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Zip | 78745-1108
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Country | US
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Telephone | 512-383-9000
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Fax | 512-383-9006
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Provider Business Mailing Address
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Address Line | 4203A JAMES CASEY ST
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City | AUSTIN
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State | TX
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Zip | 78745-1108
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Country | US
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Telephone | 512-383-9000
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Fax | 512-383-9006
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | HAIDER AL-WISHAH
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Credential |
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Telephone | 512-708-0370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28387
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License Number State | TX
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