Provider Demographics
NPI:1265040828
Name:IKHILE, AUGUSTA
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:
Last Name:IKHILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 WINTER LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1000
Mailing Address - Country:US
Mailing Address - Phone:510-589-3265
Mailing Address - Fax:
Practice Address - Street 1:10633 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-3805
Practice Address - Country:US
Practice Address - Phone:510-589-3265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy