Provider Demographics
NPI:1932713211
Name:PEOPLES PHARMACY
Entity Type:Organization
Organization Name:PEOPLES PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-447-1799
Mailing Address - Street 1:3801 S LAMAR BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8173
Mailing Address - Country:US
Mailing Address - Phone:512-447-1799
Mailing Address - Fax:512-441-5335
Practice Address - Street 1:4120 COMMERCIAL CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-1058
Practice Address - Country:US
Practice Address - Phone:512-646-4007
Practice Address - Fax:512-674-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy