Provider Demographics
NPI:1891780797
Name:A & G PHARMACY SERVICE INC
Entity Type:Organization
Organization Name:A & G PHARMACY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTONIETTE
Authorized Official - Middle Name:ALFONSINA
Authorized Official - Last Name:BARBUTO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-375-1230
Mailing Address - Street 1:2665 BRODHEAD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2723
Mailing Address - Country:US
Mailing Address - Phone:724-375-1230
Mailing Address - Fax:
Practice Address - Street 1:2665 BRODHEAD RD
Practice Address - Street 2:SUITE B
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2723
Practice Address - Country:US
Practice Address - Phone:724-375-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414481L333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0137400001Medicare ID - Type Unspecified