Provider Demographics
NPI:1063177723
Name:BARANCIN, AUSTIN MATTHEW
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:MATTHEW
Last Name:BARANCIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45338-9515
Mailing Address - Country:US
Mailing Address - Phone:765-277-6922
Mailing Address - Fax:
Practice Address - Street 1:950 E GREENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-8448
Practice Address - Country:US
Practice Address - Phone:765-584-3028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029343A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist