Provider Demographics
NPI:1336512862
Name:AGIA PHARMACY & CAFE INC
Entity Type:Organization
Organization Name:AGIA PHARMACY & CAFE INC
Other - Org Name:AGIA PHARMACY & CAFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:AMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-912-2607
Mailing Address - Street 1:10900 HARTLAND ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-7004
Mailing Address - Country:US
Mailing Address - Phone:661-912-2607
Mailing Address - Fax:661-589-7916
Practice Address - Street 1:276 S MILL ST STE A
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1628
Practice Address - Country:US
Practice Address - Phone:661-823-4111
Practice Address - Fax:661-823-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CA538113336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155141OtherPK