Provider Demographics
NPI:1205154416
Name:AUGUSTINE, TERRI (RPH)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FALLS RD
Mailing Address - Street 2:PO BOX 407
Mailing Address - City:MOODUS
Mailing Address - State:CT
Mailing Address - Zip Code:06469-1210
Mailing Address - Country:US
Mailing Address - Phone:860-873-1481
Mailing Address - Fax:860-873-2490
Practice Address - Street 1:26 FALLS RD
Practice Address - Street 2:
Practice Address - City:MOODUS
Practice Address - State:CT
Practice Address - Zip Code:06469-1210
Practice Address - Country:US
Practice Address - Phone:860-873-1481
Practice Address - Fax:860-873-2490
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist