Provider Demographics
NPI:1548865181
Name:KOELKER, AUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:KOELKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 GUADALUPE ST STE B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4843
Mailing Address - Country:US
Mailing Address - Phone:512-474-2323
Mailing Address - Fax:
Practice Address - Street 1:2402 GUADALUPE ST STE B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4843
Practice Address - Country:US
Practice Address - Phone:512-474-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43250183500000X
TX67879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist