Provider Demographics
NPI:1508978412
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 PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-495-2535
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 1:132 W MAIN ST
Practice Address - Street 2:
Practice Address - City:POST
Practice Address - State:TX
Practice Address - Zip Code:79356-3232
Practice Address - Country:US
Practice Address - Phone:806-495-2535
Practice Address - Fax:806-495-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX231943336C0003X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148198Medicaid
TX145388Medicaid
5521620001Medicare NSC