Active NPI
Gallissara Agavatpanitch, R.PH.
- Pharmacist
- San Antonio, TX
National Provider Identifier
1689165342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 60954
- Practice address
- 7400 Merton Minter St
San Antonio, TX 78229-4404 - Phone
- (210) 617-5300
- NPI assigned
- May 29, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 60954 | TX | Primary |
Addresses
Primary practice location
7400 Merton Minter St
San Antonio, TX 78229-4404
Mailing address
76 Veterans Ave
Bath, NY 14810-0810
Phone (607) 664-4415
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60954 | Other | TX | TEXAS STATE BOARD OF PHARMACY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60954 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744761600000",
"number": "1689165342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 VETERANS AVE",
"city": "BATH",
"state": "NY",
"postal_code": "148100810",
"telephone_number": "607-664-4415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7400 MERTON MINTER ST",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782294404",
"telephone_number": "210-617-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGAVATPANITCH",
"first_name": "GALLISSARA",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-29",
"last_updated": "2025-04-16",
"certification_date": "2025-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "60954",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS STATE BOARD OF PHARMACY",
"identifier": "60954",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.