Provider Demographics
NPI:1457692709
Name:EMMITT, JOHN CHARLES (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:EMMITT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 MATTIE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-5459
Mailing Address - Country:US
Mailing Address - Phone:512-517-4810
Mailing Address - Fax:
Practice Address - Street 1:1080 HWY 290 E
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2519
Practice Address - Country:US
Practice Address - Phone:512-285-4719
Practice Address - Fax:512-281-0507
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist