Provider Demographics
NPI:1366761850
Name:AUSTIN'S PHARMACY INC.
Entity type:Organization
Organization Name:AUSTIN'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:ERUACHABOR
Authorized Official - Last Name:ATIYOTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:760-922-5966
Mailing Address - Street 1:1345 W HOBSONWAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1425
Mailing Address - Country:US
Mailing Address - Phone:760-921-2017
Mailing Address - Fax:
Practice Address - Street 1:1345 W HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1425
Practice Address - Country:US
Practice Address - Phone:760-921-2017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 49945333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy