Provider Demographics
NPI:1255673745
Name:LAGRANGE PHARMACY INC.
Entity Type:Organization
Organization Name:LAGRANGE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-447-1343
Mailing Address - Street 1:1520 ROUTE 55
Mailing Address - Street 2:UNIT #16
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5236
Mailing Address - Country:US
Mailing Address - Phone:845-447-1343
Mailing Address - Fax:845-384-1115
Practice Address - Street 1:1520 ROUTE 55
Practice Address - Street 2:UNIT #16
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5236
Practice Address - Country:US
Practice Address - Phone:845-447-1343
Practice Address - Fax:845-384-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031906333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy