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General NPI Number Information
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NPI Number | 1912196932
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Entity Type | Organization
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Legal Business Name | ACE MEDICAL PHARMACY
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 611 W BEN WHITE BLVD
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City | AUSTIN
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State | TX
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Zip | 78704-7187
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Country | US
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Telephone | 512-444-2391
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Fax | 512-444-5560
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Provider Business Mailing Address
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Address Line | 611 W BEN WHITE BLVD
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City | AUSTIN
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State | TX
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Zip | 78704-7187
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | PAUL MAYHALL
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Credential | RPH
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Telephone | 512-444-2391
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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 | 22286
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License Number State | TX
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