Provider Demographics
NPI:1952909905
Name:AUGUSTINE, ASHLEY LOUISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LOUISE
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:LOUISE
Other - Last Name:AUGUSTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 12TH ST SW
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-1482
Mailing Address - Country:US
Mailing Address - Phone:651-464-9742
Mailing Address - Fax:651-464-9725
Practice Address - Street 1:200 12TH ST SW
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-1482
Practice Address - Country:US
Practice Address - Phone:651-464-9742
Practice Address - Fax:651-464-9725
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist