Provider Demographics
NPI:1053028522
Name:AUGUSTE, WILTHERKEEN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:WILTHERKEEN
Middle Name:
Last Name:AUGUSTE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 N BROAD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2302
Mailing Address - Country:US
Mailing Address - Phone:215-424-2611
Mailing Address - Fax:215-424-6927
Practice Address - Street 1:5751 N BROAD ST STE 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2302
Practice Address - Country:US
Practice Address - Phone:215-424-2611
Practice Address - Fax:215-424-6927
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist