Provider Demographics
NPI:1730851494
Name:BUI, AUGUSTINE CONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:CONG
Last Name:BUI
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 1:5020 GRAPE RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545
Mailing Address - Country:US
Mailing Address - Phone:574-273-3510
Mailing Address - Fax:574-273-3565
Practice Address - Street 1:5020 GRAPE RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-273-3510
Practice Address - Fax:574-273-3565
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413706183500000X
TN44427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist