Healthcare Provider Details

I. General information

NPI: 1336512862
Provider Name (Legal Business Name): AGIA PHARMACY & CAFE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 S MILL ST STE A
TEHACHAPI CA
93561-1628
US

IV. Provider business mailing address

10900 HARTLAND ST
BAKERSFIELD CA
93312-7004
US

V. Phone/Fax

Practice location:
  • Phone: 661-823-4111
  • Fax: 661-823-4734
Mailing address:
  • Phone: 661-912-2607
  • Fax: 661-589-7916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number53811
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMIRA MICHAEL
Title or Position: OWNER, PIC, AO
Credential: RPH
Phone: 661-912-2607