MEDICARE: DR. MARVENE AUGUSTUS PHARMD, RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	11201	LA

General Provider Information

NPI Number	:	1568797850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVENE AUGUSTUS PHARMD, RPH

Provider Business Mailing Address
First Line	:	9807 VOUVRAY DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-7646
Country	:	US
Telephone Number	:	225-753-7140
Fax Number	:	225-358-4992

Provider Business Practice Location Address
First Line	:	9807 VOUVRAY DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-7646
Country	:	US
Telephone Number	:	225-753-7140
Fax Number	:	225-358-4992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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