Provider Demographics
NPI:1063821890
Name:AUGUSTINE, REBECCA (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 WISCONSIN AVE.
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805
Mailing Address - Country:US
Mailing Address - Phone:608-375-4466
Mailing Address - Fax:608-375-2383
Practice Address - Street 1:1028 WISCONSIN AVE.
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805
Practice Address - Country:US
Practice Address - Phone:608-375-4466
Practice Address - Fax:608-375-2383
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171400000X
WI17573-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171400000XOther Service ProvidersHealth & Wellness Coach