Provider Demographics
NPI:1558474734
Name:38TH STREET PHARMACY, INC.
Entity type:Organization
Organization Name:38TH STREET PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WARNKEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:512-458-3784
Mailing Address - Street 1:711 W 38TH ST STE C3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1126
Mailing Address - Country:US
Mailing Address - Phone:512-458-3784
Mailing Address - Fax:512-458-1882
Practice Address - Street 1:711 W 38TH ST STE C3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1126
Practice Address - Country:US
Practice Address - Phone:512-458-3784
Practice Address - Fax:512-458-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13873183500000X
TX0812860001332B00000X
3336C0003X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143636Medicaid
4582587OtherNABP
TX0812860001OtherMEDICARE