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General NPI Number Information
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NPI Number | 1912375775
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Entity Type | Organization
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Legal Business Name | THE AUSTIN DIAGNOSTIC CLINIC ASSOCIATION
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 12221 N MOPAC EXPY SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78758-2401
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Country | US
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Telephone | 512-901-4797
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Fax | 512-901-3967
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Provider Business Mailing Address
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Address Line | PO BOX 55379 DEPT # 10100 C/O PHARMAPOINT
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City | BIRMINGHAM
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State | AL
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Zip | 35255-5379
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Country | US
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Telephone | 205-795-8800
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. BLAKE R LANCASTER
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Credential |
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Telephone | 205-795-8800
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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 | 30073
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License Number State | TX
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