Provider Demographics
NPI:1912375775
Name:THE AUSTIN DIAGNOSTIC CLINIC ASSOCIATION
Entity Type:Organization
Organization Name:THE AUSTIN DIAGNOSTIC CLINIC ASSOCIATION
Other - Org Name:THE AUSTIN DIAGNOSTIC CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-795-8800
Mailing Address - Street 1:PO BOX 55379
Mailing Address - Street 2:DEPT # 10100 C/O PHARMAPOINT
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5379
Mailing Address - Country:US
Mailing Address - Phone:205-795-8800
Mailing Address - Fax:
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4797
Practice Address - Fax:512-901-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy