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NPI Code Detail

MEDICARE: DR. AUSTIN THOMAS MONDLOCH PHARMD

MEDICARE: DR. AUSTIN THOMAS MONDLOCH PHARMD
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
11835P1200XPharmacotherapy Pharmacist26030450AIN

General Provider Information

NPI Number : 1477483329
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AUSTIN THOMAS MONDLOCH PHARMD
Provider Business Mailing Address
First Line : 10627 DIEBOLD RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-8606
Country : US
Telephone Number : 920-918-1110
Fax Number :
Provider Business Practice Location Address
First Line : 10627 DIEBOLD RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-8606
Country : US
Telephone Number : 920-918-1110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2026
Last Update Date : 05/21/2026

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