MEDICARE: A.E. PHARMACY, LLC

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	3336C0003X	Community/Retail Pharmacy	30875	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2160596	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285084467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.E. PHARMACY, LLC

Provider Business Mailing Address
First Line	:	4500 S PLEASANT VALLEY RD STE 201
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-2911
Country	:	US
Telephone Number	:	855-745-5725
Fax Number	:	603-935-9108

Provider Business Practice Location Address
First Line	:	4500 S PLEASANT VALLEY ROAD
Second Line	:	SUITE 201
City	:	AUSTIN
State	:	TX
Zip	:	78744-2911
Country	:	US
Telephone Number	:	512-537-3205
Fax Number	:	512-677-6267

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TANVI JAYANTI PATEL
Credential	:
Telephone Number	:	855-745-5725

Provider Enumeration Date	:	06/17/2016
Last Update Date	:	09/08/2025

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Directions to “A.E. PHARMACY, LLC ” Practice Location

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