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General NPI Number Information
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NPI Number | 1831584242
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Entity Type | Organization
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Legal Business Name | ECO PHARMACY OF SOUTH AUSTIN LLC
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 11420 BEE CAVES RD STE B100
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City | AUSTIN
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State | TX
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Zip | 78738
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Country | US
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Telephone | 512-519-9248
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Fax | 512-519-9238
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Provider Business Mailing Address
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Address Line | 11420 BEE CAVES RD STE B100
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City | AUSTIN
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State | TX
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Zip | 78738-5529
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Country | US
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Telephone | 512-643-0411
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Fax | 512-519-9238
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN KUYKENDALL
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Credential |
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Telephone | 512-643-0411
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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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