Healthcare Provider Details

I. General information

NPI: 1811442502
Provider Name (Legal Business Name): AGIOS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S BAY ST
EUSTIS FL
32726-5551
US

IV. Provider business mailing address

1314 S BAY ST
EUSTIS FL
32726-5551
US

V. Phone/Fax

Practice location:
  • Phone: 407-968-6818
  • Fax:
Mailing address:
  • Phone: 352-357-6699
  • Fax: 352-357-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH30203
License Number StateFL

VIII. Authorized Official

Name: JOHN MANSOUR
Title or Position: CEO
Credential: PHARMACIST
Phone: 352-357-6699