Provider Demographics
NPI:1497641047
Name:BOURKE, AUSTIN WILLIAM (CPHT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:WILLIAM
Last Name:BOURKE
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:AUSTIN
Other - Middle Name:WILLIAM
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:8571 BAYBORO LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7103
Mailing Address - Country:US
Mailing Address - Phone:412-737-0681
Mailing Address - Fax:
Practice Address - Street 1:8571 BAYBORO LN
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7103
Practice Address - Country:US
Practice Address - Phone:412-737-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC68114183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician