Provider Demographics
NPI:1043588171
Name:WAHLE, AUSTIN LEE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:LEE
Last Name:WAHLE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24782 PERSEUS CT
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4733
Mailing Address - Country:US
Mailing Address - Phone:831-443-8717
Mailing Address - Fax:831-443-0413
Practice Address - Street 1:1532 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-5101
Practice Address - Country:US
Practice Address - Phone:831-443-8717
Practice Address - Fax:831-883-0413
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist