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General NPI Number Information
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NPI Number | 1003453705
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Entity Type | Individual
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Provider Name | ANDREW AGUSTIN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 1131 KUALA ST
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City | PEARL CITY
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State | HI
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Zip | 96782-2886
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Country | US
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Telephone | 808-454-8792
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Fax |
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Provider Business Mailing Address
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Address Line | 91-2012 LAAKONA PL
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City | EWA BEACH
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State | HI
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Zip | 96706-4020
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Country | US
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Telephone | 808-392-5666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH-4504
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License Number State | HI
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