Healthcare Provider Details

I. General information

NPI: 1790127074
Provider Name (Legal Business Name): AUGUSTINE GABRIEL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WATKINS MILL RD
GAITHERSBURG MD
20879-3301
US

IV. Provider business mailing address

401 HOLLAND LN APT 719
ALEXANDRIA VA
22314-3438
US

V. Phone/Fax

Practice location:
  • Phone: 240-632-4283
  • Fax:
Mailing address:
  • Phone: 786-205-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPS39472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: