Provider Demographics
NPI:1629112412
Name:WASKO, EMMA ELIZABETH
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ELIZABETH
Last Name:WASKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 KENDAL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753
Mailing Address - Country:US
Mailing Address - Phone:512-837-4590
Mailing Address - Fax:
Practice Address - Street 1:11209 METRIC BLVD BLDG H
Practice Address - Street 2:VENDOR DRUG PROGRAM H 630
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-491-1155
Practice Address - Fax:512-491-1961
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115944183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician