Provider Demographics
NPI:1316347248
Name:AUSTIN WELLNESS PHARMACY LLC.
Entity type:Organization
Organization Name:AUSTIN WELLNESS PHARMACY LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAN
Authorized Official - Middle Name:YEE
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-263-6688
Mailing Address - Street 1:6902 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4233
Mailing Address - Country:US
Mailing Address - Phone:718-263-6688
Mailing Address - Fax:718-263-6690
Practice Address - Street 1:6902 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4233
Practice Address - Country:US
Practice Address - Phone:718-263-6688
Practice Address - Fax:718-263-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0329773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy