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General NPI Number Information
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NPI Number | 1366761850
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Entity Type | Organization
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Legal Business Name | AUSTIN'S PHARMACY INC.
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Dates
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Enumeration Date | 05/23/2010
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Last Update Date | 05/23/2010
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Provider Practice Location Address
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Address Line | 1345 W HOBSONWAY
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City | BLYTHE
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State | CA
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Zip | 92225-1425
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Country | US
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Telephone | 760-921-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 W HOBSONWAY
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City | BLYTHE
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State | CA
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Zip | 92225-1425
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Country | US
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Telephone | 760-921-2017
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. AUGUSTINE ERUACHABOR ATIYOTA
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Credential | PHARM.D
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Telephone | 760-922-5966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY 49945
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License Number State | CA
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