Organization
SOUTH AUSTIN PHARMACY LLC
Active
Other names
South Austin Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
HAIDER AL-WISHAH (PHARMACIST IN CHARGE)
(512) 708-0370
Entity
Organization
Contact information
Practice address
4203A JAMES CASEY ST, AUSTIN, TX 78745-1108
(512) 383-9000
(512) 383-9006
Mailing address
4203A JAMES CASEY ST, AUSTIN, TX 78745-1108
(512) 383-9000
(512) 383-9006
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28387
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801132873
—
TX
01
—
5907893
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/19/2012
Last updated
02/12/2013
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