Healthcare Provider Details

I. General information

NPI: 1568457364
Provider Name (Legal Business Name): FREDERICK J. AUGELLO JR. RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 LAWRENCEVILLE HWY NW
LILBURN GA
30047-2817
US

IV. Provider business mailing address

5890 OLDE ATLANTA PKWY
SUWANEE GA
30024-3451
US

V. Phone/Fax

Practice location:
  • Phone: 770-935-0061
  • Fax: 770-935-0069
Mailing address:
  • Phone: 770-313-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number014558
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: