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General NPI Number Information
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NPI Number | 1265040828
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Entity Type | Individual
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Provider Name | AUGUSTA IKHILE
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Gender | Female
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 10633 INTERNATIONAL BLVD
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City | OAKLAND
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State | CA
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Zip | 94603-3805
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Country | US
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Telephone | 510-589-3265
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Fax |
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Provider Business Mailing Address
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Address Line | 183 WINTER LN
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City | MOUNTAIN HOUSE
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State | CA
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Zip | 95391-1000
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Country | US
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Telephone | 510-589-3265
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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