1235224122 NPI number — AUSTIN P HORN

Table of content: (NPI 1235224122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235224122 NPI number — AUSTIN P HORN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTIN P HORN
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:
1235224122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97 US MAIL
Provider Second Line Business Mailing Address:
111 PIUTE DRIVE PHYSICAL
Provider Business Mailing Address City Name:
KERNVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93238-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-376-2216
Provider Business Mailing Address Fax Number:
760-376-3855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 PIUTE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERNVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93238-0097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-376-2216
Provider Business Practice Location Address Fax Number:
760-376-3855
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HORN
Authorized Official First Name:
AUSTIN
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
PHARMACIST IN CHARGE/OWNER
Authorized Official Telephone Number:
760-376-2216

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY46309 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHA463090 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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