=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720732993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGATENO TECHNOLOGIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2022
-----------------------------------------------------
Last Update Date | 02/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3648 OLD DENTON RD STE 104
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75007-7977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-800-5526
-----------------------------------------------------
Fax | 214-329-1203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3648 OLD DENTON RD STE 104
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75007-7977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-800-5526
-----------------------------------------------------
Fax | 214-329-1203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | MR. SHINU PUNNOOSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-800-5526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------