Healthcare Provider Details

I. General information

NPI: 1497641047
Provider Name (Legal Business Name): AUSTIN WILLIAM BOURKE CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AUSTIN WILLIAM O'MALLEY CPHT

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8571 BAYBORO LN
NORTH CHARLESTON SC
29420-7103
US

IV. Provider business mailing address

8571 BAYBORO LN
NORTH CHARLESTON SC
29420-7103
US

V. Phone/Fax

Practice location:
  • Phone: 412-737-0681
  • Fax:
Mailing address:
  • Phone: 412-737-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number68114
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: