Healthcare Provider Details

I. General information

NPI: 1124105812
Provider Name (Legal Business Name): LAGRANGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 FREEDOM PLAINS RD
POUGHKEEPSIE NY
12603-6710
US

IV. Provider business mailing address

702 FREEDOM PLAINS RD
POUGHKEEPSIE NY
12603-6710
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-4330
  • Fax: 845-471-5798
Mailing address:
  • Phone: 845-471-4330
  • Fax: 845-471-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number015891
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CAPRIOLI
Title or Position: PRESIDENT
Credential:
Phone: 845-471-4330