Provider Demographics
NPI:1528607223
Name:AGAPE TRADERS
Entity Type:Organization
Organization Name:AGAPE TRADERS
Other - Org Name:LILI CLARKE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LIRIETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-608-0890
Mailing Address - Street 1:562 INDEPENDENCE RD STE 142
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9702
Mailing Address - Country:US
Mailing Address - Phone:610-608-0890
Mailing Address - Fax:
Practice Address - Street 1:562 INDEPENDENCE RD STE 142
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9702
Practice Address - Country:US
Practice Address - Phone:610-608-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier