Provider Demographics
NPI:1407345143
Name:CHEMIST LABORATORY, LLC
Entity Type:Organization
Organization Name:CHEMIST LABORATORY, LLC
Other - Org Name:HILL COUNTRY APOTHECARY BEE CAVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY TEAMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-351-9139
Mailing Address - Street 1:3944 RANCH ROAD 620S
Mailing Address - Street 2:BLDG 6
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738
Mailing Address - Country:US
Mailing Address - Phone:512-351-9139
Mailing Address - Fax:512-366-5573
Practice Address - Street 1:3944 RANCH ROAD 620 S BLDG 6
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6301
Practice Address - Country:US
Practice Address - Phone:512-351-9139
Practice Address - Fax:512-366-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX319843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176626OtherPK