Healthcare Provider Details

I. General information

NPI: 1982924270
Provider Name (Legal Business Name): DUSTIN L AUGUST PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W BELL ST
GLENDIVE MT
59330-3240
US

IV. Provider business mailing address

1515 W BELL ST
GLENDIVE MT
59330-3240
US

V. Phone/Fax

Practice location:
  • Phone: 406-365-9642
  • Fax: 406-365-9866
Mailing address:
  • Phone: 406-365-9642
  • Fax: 406-365-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-14639
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: