Provider Demographics
NPI:1134348899
Name:AGOVINO, ADAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:AGOVINO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GRAY FARMS RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2509
Mailing Address - Country:US
Mailing Address - Phone:917-375-7944
Mailing Address - Fax:718-543-0756
Practice Address - Street 1:3887 SEDGWICK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4432
Practice Address - Country:US
Practice Address - Phone:718-543-3116
Practice Address - Fax:718-543-0756
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist