Provider Demographics
NPI:1598337537
Name:CAIN, AUSTIN
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:CAIN
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 1:404 N KEENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6626
Mailing Address - Country:US
Mailing Address - Phone:573-875-9000
Mailing Address - Fax:
Practice Address - Street 1:1729 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1190
Practice Address - Country:US
Practice Address - Phone:573-445-9451
Practice Address - Fax:573-446-2844
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-10
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200150931835I0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835I0206XPharmacy Service ProvidersPharmacistInfectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
30142560OtherCPHT LICENSE
MO2020015093OtherMO BOARD OF PROFESSIONAL REGISTRATION LICENSE