Provider Demographics
NPI:1710644620
Name:HAUSHALTER, AMANDA CHRISTINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:HAUSHALTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 GRASSHOPPER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5628
Mailing Address - Country:US
Mailing Address - Phone:314-452-7174
Mailing Address - Fax:
Practice Address - Street 1:8500 SHOAL CREEK BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6888
Practice Address - Country:US
Practice Address - Phone:855-617-7312
Practice Address - Fax:855-617-7313
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist