Provider Demographics
NPI:1235476367
Name:ATIYOTA, AUGUSTINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:
Last Name:ATIYOTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AUGUSTINE
Other - Middle Name:
Other - Last Name:ATIYOTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:740 OLEANDER LN
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1322
Mailing Address - Country:US
Mailing Address - Phone:760-922-5966
Mailing Address - Fax:760-921-2020
Practice Address - Street 1:1345 W HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1425
Practice Address - Country:US
Practice Address - Phone:760-921-2017
Practice Address - Fax:760-921-2020
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3980609OtherSTATE OF CALIFORNIA