MEDICARE: CPRX PHARMACY LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	29290	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2147224	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063464469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CPRX PHARMACY LP

Provider Business Mailing Address
First Line	:	4303 VICTORY DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7507
Country	:	US
Telephone Number	:	512-382-7393
Fax Number	:	512-382-7488

Provider Business Practice Location Address
First Line	:	3811 BEE CAVES RD STE 100
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5310
Country	:	US
Telephone Number	:	512-382-7393
Fax Number	:	512-382-7488

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHELLE HOLLE
Credential	:
Telephone Number	:	512-652-0120

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	05/06/2025

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