Provider Demographics
NPI:1902920986
Name:AUGUSTINE, SAMUEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9514 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3747
Mailing Address - Country:US
Mailing Address - Phone:402-393-4839
Mailing Address - Fax:402-280-1268
Practice Address - Street 1:2500 CALIFORNIA PLAZA
Practice Address - Street 2:CU - SPAHP HIXSON LIED SCIENCE BUILDING RM 153
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68178
Practice Address - Country:US
Practice Address - Phone:402-280-2756
Practice Address - Fax:402-280-1268
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE83661835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear