Provider Demographics
NPI:1215635263
Name:AGUSTIN, ROMMEL MANUEL (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ROMMEL
Middle Name:MANUEL
Last Name:AGUSTIN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 IMOLA CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8153
Mailing Address - Country:US
Mailing Address - Phone:661-889-0334
Mailing Address - Fax:
Practice Address - Street 1:3101 N SILLECT AVE STE 115
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6348
Practice Address - Country:US
Practice Address - Phone:661-489-5309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist