MEDICARE: MS. MAUREEN NASH AUGUSTINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11792-40	WI
2	183500000X	Pharmacist	RP030753L	PA

General Provider Information

NPI Number	:	1194009183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN NASH AUGUSTINE

Provider Business Mailing Address
First Line	:	6118 W BLUEMOUND RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-4143
Country	:	US
Telephone Number	:	414-771-5606
Fax Number	:

Provider Business Practice Location Address
First Line	:	6118 W BLUEMOUND RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-4143
Country	:	US
Telephone Number	:	414-771-5606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/07/2011

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