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General NPI Number Information
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NPI Number | 1467574970
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Entity Type | Organization
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Legal Business Name | AGUSTIN PHARMACY INC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 3920 29TH ST
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-3708
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Country | US
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Telephone | 718-937-8160
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Fax | 718-937-8154
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Provider Business Mailing Address
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Address Line | 3920 29TH ST
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-3708
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Country | US
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Telephone | 718-937-8160
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Fax | 718-937-8154
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | MR. FRANK CAPPELLO
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Credential | RPH
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Telephone | 718-937-8160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 028110
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License Number State | NY
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