Provider Demographics
NPI:1235224122
Name:AUSTIN P HORN
Entity Type:Organization
Organization Name:AUSTIN P HORN
Other - Org Name:THE DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:760-376-2216
Mailing Address - Street 1:PO BOX 97 US MAIL
Mailing Address - Street 2:111 PIUTE DRIVE PHYSICAL
Mailing Address - City:KERNVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93238-0097
Mailing Address - Country:US
Mailing Address - Phone:760-376-2216
Mailing Address - Fax:760-376-3855
Practice Address - Street 1:111 PIUTE DRIVE
Practice Address - Street 2:
Practice Address - City:KERNVILLE
Practice Address - State:CA
Practice Address - Zip Code:93238-0097
Practice Address - Country:US
Practice Address - Phone:760-376-2216
Practice Address - Fax:760-376-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY463093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA463090Medicaid
5130630001Medicare ID - Type Unspecified