Provider Demographics
NPI:1629348644
Name:AUGUSTIN, FRED
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 THOMSON WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6421
Mailing Address - Country:US
Mailing Address - Phone:561-792-4077
Mailing Address - Fax:
Practice Address - Street 1:5352 LINTON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-495-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 34499183500000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 39944OtherRPH LICENCE NUMBER