Provider Demographics
NPI:1831584242
Name:ECO PHARMACY OF SOUTH AUSTIN LLC
Entity type:Organization
Organization Name:ECO PHARMACY OF SOUTH AUSTIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-643-0411
Mailing Address - Street 1:11420 BEE CAVES RD STE B100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5529
Mailing Address - Country:US
Mailing Address - Phone:512-643-0411
Mailing Address - Fax:512-519-9238
Practice Address - Street 1:11420 BEE CAVES RD STE B100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738
Practice Address - Country:US
Practice Address - Phone:512-519-9248
Practice Address - Fax:512-519-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151120OtherPK