Provider Demographics
NPI:1073332466
Name:MONTGOMERY, AUSTIN (RPH)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:MONTGOMERY
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 1:2221 SE 6TH LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2897
Mailing Address - Country:US
Mailing Address - Phone:239-898-6625
Mailing Address - Fax:
Practice Address - Street 1:4065 HANCOCK BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4294
Practice Address - Country:US
Practice Address - Phone:399-970-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist