1063464469 NPI number — CPRX PHARMACY LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063464469 NPI number — CPRX PHARMACY LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPRX PHARMACY LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063464469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4303 VICTORY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704-7507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-382-7393
Provider Business Mailing Address Fax Number:
512-382-7488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3811 BEE CAVES RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LAKE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-382-7393
Provider Business Practice Location Address Fax Number:
512-382-7488
Provider Enumeration Date:
05/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLLE
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
512-652-0120

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 29290 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2147224 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 147012 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".