Provider Demographics
NPI:1942805585
Name:AUGE, MARY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:AUGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LACON
Mailing Address - State:IL
Mailing Address - Zip Code:61540-1211
Mailing Address - Country:US
Mailing Address - Phone:309-246-2555
Mailing Address - Fax:309-246-2387
Practice Address - Street 1:415 5TH ST
Practice Address - Street 2:
Practice Address - City:LACON
Practice Address - State:IL
Practice Address - Zip Code:61540-1211
Practice Address - Country:US
Practice Address - Phone:309-246-2555
Practice Address - Fax:309-246-2387
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-038914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist