Provider Demographics
NPI:1508333782
Name:AUSTIN, JOEL ADAM
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ADAM
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 WOODRUFF ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15211-1515
Mailing Address - Country:US
Mailing Address - Phone:412-680-3384
Mailing Address - Fax:
Practice Address - Street 1:818 E WARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-1560
Practice Address - Country:US
Practice Address - Phone:412-431-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP447320OtherPHARMACIST LICENSE