Provider Demographics
NPI:1457824864
Name:AUSTIN, IRA CONRAD III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:CONRAD
Last Name:AUSTIN
Suffix:III
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 1:8232 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-2042
Mailing Address - Country:US
Mailing Address - Phone:504-866-7979
Mailing Address - Fax:
Practice Address - Street 1:8232 OAK ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-2042
Practice Address - Country:US
Practice Address - Phone:504-866-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist