Provider Demographics
NPI:1316032428
Name:AUSTIN PHARMACY
Entity type:Organization
Organization Name:AUSTIN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:CLEVE
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:409-994-3578
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:15558 FM 1004 W
Mailing Address - City:BUNA
Mailing Address - State:TX
Mailing Address - Zip Code:77612-0310
Mailing Address - Country:US
Mailing Address - Phone:409-994-3578
Mailing Address - Fax:409-994-5718
Practice Address - Street 1:15558 FM 1004 W
Practice Address - Street 2:
Practice Address - City:BUNA
Practice Address - State:TX
Practice Address - Zip Code:77612
Practice Address - Country:US
Practice Address - Phone:409-994-3578
Practice Address - Fax:409-994-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15224183500000X
TX19231183500000X
TX116106183700000X
TX112330183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17483OtherSTORE LICENSE
TX4588286OtherNABP
TXBA5206392OtherDEA