Individual provider Active NPI

Wiltherkeen Auguste, PHARMACIST

  • Pharmacist
  • Philadelphia, PA
National Provider Identifier
1053028522
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RP038923 Issued in PA
Practice address
5751 N Broad St Ste 3
Philadelphia, PA 19141-2302
Phone
(215) 424-2611
Fax
(215) 424-6927
NPI assigned
Nov 3, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RP038923 PA Primary

Addresses

Primary practice location

5751 N Broad St Ste 3
Philadelphia, PA 19141-2302

Mailing address

5751 N Broad St Ste 3
Philadelphia, PA 19141-2302
Phone (215) 424-2611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RP038923PAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Sdarbouze Apothecary Inc. CurrentSince Nov 6, 2022 Accepting new patients

Locations

5751 N Broad St
Ste 3
Philadelphia, PA 19141
Phone (215) 424-2611

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1053028522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5751 N BROAD ST STE 3",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191412302",
            "telephone_number": "215-424-2611",
            "fax_number": "215-424-6927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5751 N BROAD ST STE 3",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191412302",
            "telephone_number": "215-424-2611",
            "fax_number": "215-424-6927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AUGUSTE",
        "first_name": "WILTHERKEEN",
        "credential": "PHARMACIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-03",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP038923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.