Provider Demographics
NPI:1891859039
Name:AUST, RICHARD T (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:AUST
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 1:18 BERRIOS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1003
Mailing Address - Country:US
Mailing Address - Phone:860-688-5448
Mailing Address - Fax:
Practice Address - Street 1:84 PROGRESS LN
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3829
Practice Address - Country:US
Practice Address - Phone:203-753-7778
Practice Address - Fax:203-346-7593
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19525OtherMA PHARMACIST LICENSE
CT6569OtherCT PHARMACIST LICENSE