Provider Demographics
NPI:1396015798
Name:AUGUSTIN, FRUSNEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:FRUSNEL
Middle Name:
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 30TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-4091
Mailing Address - Country:US
Mailing Address - Phone:239-240-4345
Mailing Address - Fax:239-931-3605
Practice Address - Street 1:8246 SILVER BIRCH WAY
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-3718
Practice Address - Country:US
Practice Address - Phone:239-240-0824
Practice Address - Fax:239-658-1310
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1396015798Medicaid