Healthcare Provider Details

I. General information

NPI: 1356609358
Provider Name (Legal Business Name): AGP PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 OLTON RD B
PLAINVIEW TX
79072-6653
US

IV. Provider business mailing address

3200 OLTON RD STE B
PLAINVIEW TX
79072-6653
US

V. Phone/Fax

Practice location:
  • Phone: 806-296-9000
  • Fax: 806-296-9001
Mailing address:
  • Phone: 806-296-9000
  • Fax: 806-296-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number27995
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALISA GWEN PETERS
Title or Position: OWNER/MANAGER
Credential: R.PH.
Phone: 806-543-1337