Provider Demographics
NPI:1427558386
Name:AGP PHARMACY LLC
Entity Type:Organization
Organization Name:AGP PHARMACY LLC
Other - Org Name:HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-296-9000
Mailing Address - Street 1:3200 OLTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-6653
Mailing Address - Country:US
Mailing Address - Phone:806-296-9000
Mailing Address - Fax:806-296-9001
Practice Address - Street 1:701 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:TX
Practice Address - Zip Code:79257-2565
Practice Address - Country:US
Practice Address - Phone:806-823-2109
Practice Address - Fax:806-823-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX295293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149957Medicaid