Provider Demographics
NPI:1811364078
Name:PEOPLES PHARMACY
Entity Type:Organization
Organization Name:PEOPLES PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-447-1799
Mailing Address - Street 1:12545 RIATA VISTA CIRCLE, MS:578-AWC
Mailing Address - Street 2:AT APPLE WELLNESS CENTER
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727
Mailing Address - Country:US
Mailing Address - Phone:512-215-3296
Mailing Address - Fax:512-910-2826
Practice Address - Street 1:5505 W. PARMER LANE, BUILDING 4
Practice Address - Street 2:AT APPLE WELLNESS CENTER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727
Practice Address - Country:US
Practice Address - Phone:512-215-3296
Practice Address - Fax:512-910-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy