MEDICARE: TARRYTOWN PHARMACY

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1972133544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRYTOWN PHARMACY

Provider Business Mailing Address
First Line	:	2727 EXPOSITION BLVD STE 105
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-1227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 EXPOSITION BLVD STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-1229
Country	:	US
Telephone Number	:	512-478-6419
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK D NEWBERRY
Credential	:
Telephone Number	:	512-478-6419

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	03/24/2023

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