Provider Demographics
NPI:1881285146
Name:EATINGER, AUSTIN GERALD (PHARMD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:GERALD
Last Name:EATINGER
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 1:1530 MORNINGSIDE CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8145
Mailing Address - Country:US
Mailing Address - Phone:219-314-7570
Mailing Address - Fax:
Practice Address - Street 1:52 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5522
Practice Address - Country:US
Practice Address - Phone:219-462-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028934A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist