Active NPI
Mauricio L Austin, PHARMD
- Pharmacist
- Vancouver, WA
National Provider Identifier
1174879373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH22070
- Practice address
- 13719 SE Mill Plain Blvd
Safeway Pharmacy #1519
Vancouver, WA 98684-6945 - Phone
- (360) 459-1942
- Fax
- (360) 891-4258
- NPI assigned
- Jul 25, 2012
- Last updated
- Apr 19, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH22070 | WA | Primary |
Addresses
Primary practice location
13719 SE Mill Plain Blvd
Safeway Pharmacy #1519
Vancouver, WA 98684-6945
Mailing address
PO Box 3063
Lacey, WA 98509
Phone (360) 459-1942
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6016547 | Medicaid | WA | |
| PH22070 | Other | WA | WA LICENSE |
| 4924812 | Other | WA | NABP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH22070 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681862400000",
"number": "1174879373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3063",
"city": "LACEY",
"state": "WA",
"postal_code": "98509",
"telephone_number": "360-459-1942",
"fax_number": "360-891-4258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13719 SE MILL PLAIN BLVD",
"address_2": "SAFEWAY PHARMACY #1519",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986846945",
"telephone_number": "360-459-1942",
"fax_number": "360-891-4258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AUSTIN",
"first_name": "MAURICIO",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-25",
"last_updated": "2023-04-19",
"certification_date": "2023-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH22070",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6016547",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA LICENSE",
"identifier": "PH22070",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP",
"identifier": "4924812",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.