Provider Demographics
NPI:1841805132
Name:ANDUJAR, RAFAEL DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:DAVID
Last Name:ANDUJAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 BRIARCLIFF BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2627
Mailing Address - Country:US
Mailing Address - Phone:512-928-1705
Mailing Address - Fax:512-929-7032
Practice Address - Street 1:1701 BRIARCLIFF BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2627
Practice Address - Country:US
Practice Address - Phone:512-928-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist