Provider Demographics
NPI:1336312875
Name:GAINES, MICHAEL PHILIP (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PHILIP
Last Name:GAINES
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 1:12407 N. MOPAC EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758
Mailing Address - Country:US
Mailing Address - Phone:512-339-6644
Mailing Address - Fax:512-832-9128
Practice Address - Street 1:12407 N. MOPAC EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-339-6644
Practice Address - Fax:512-832-9128
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342401835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy