MEDICARE: AG PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1952962581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AG PHARMACY, LLC

Provider Business Mailing Address
First Line	:	3322 HOLLAND RD STE A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4826
Country	:	US
Telephone Number	:	757-689-3972
Fax Number	:	757-689-4339

Provider Business Practice Location Address
First Line	:	3322 HOLLAND RD STE A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4826
Country	:	US
Telephone Number	:	757-689-3972
Fax Number	:	757-686-4339

Authorized Official
Title or Position	:	OWNER
Name	:	ADRIENNE GAUTIER
Credential	:
Telephone Number	:	757-689-3972

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	09/28/2020

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