Healthcare Provider Details

I. General information

NPI: 1154267557
Provider Name (Legal Business Name): AGATHA GRADKOWSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-0001
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6211
  • Fax:
Mailing address:
  • Phone: 610-406-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP460558
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: