Provider Demographics
NPI:1780747485
Name:AGRA PHARMACY INC
Entity type:Organization
Organization Name:AGRA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-583-2535
Mailing Address - Street 1:1575 BATHGATE AVE
Mailing Address - Street 2:AGRA PHARMACY INC
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-8216
Mailing Address - Country:US
Mailing Address - Phone:718-583-2535
Mailing Address - Fax:
Practice Address - Street 1:1575 BATHGATE AVE
Practice Address - Street 2:AGRA PHARMACY INC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8216
Practice Address - Country:US
Practice Address - Phone:718-583-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024599261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02058973Medicaid
NY02058973Medicaid