Agp Pharmacy LLC
Organization Active NPI Pharmacy · Plainview, TX
NPI 1356609358 · NPPES record last updated Sep 19, 2019
Key facts
- NPI
- 1356609358
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 27995 (TX)
- Legal business name
- AGP PHARMACY LLC
- Practice address
- 3200 Olton Rd
B
Plainview, TX 79072-6653 - Phone
- (806) 296-9000
- Fax
- (806) 296-9001
- NPI assigned
- Apr 26, 2012
- Organization subpart
- No
Authorized official
- Name
- Alisa Gwen Peters, R.PH.
- Title
- Owner/Manager
- Phone
- (806) 543-1337
Other NPIs on the same Medicare enrollment 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210423000165 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 7911108147 |
1 other NPI on this enrollment Practice locations: Plainview, TX; Post, TX |
National Provider Directory
Locations
3200 Olton Rd
Ste B
Plainview, TX 79072
Phone (806) 296-9000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 27995 | TX | Yes |
| Community/Retail Pharmacy | 3336C0003X | |||
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
3200 Olton Rd
B
Plainview, TX 79072-6653
Mailing address
3200 Olton Rd Ste B
Plainview, TX 79072-6653
Phone (806) 296-9000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 148197 | Medicaid | TX |
Other names
- Hometown Pharmacy
Other providers in Plainview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.