Active NPI
Agra Pharmacy Inc
- Community Health Clinic/Center
- Bronx, NY
National Provider Identifier
1780747485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Clinic/Center
- License
- 024599
- Legal business name
- AGRA PHARMACY INC
- Practice address
- 1575 Bathgate Ave
Agra Pharmacy Inc
Bronx, NY 10457-8216 - Phone
- (718) 583-2535
- NPI assigned
- Dec 18, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- George Thomas
- Title
- Pharmacist
- Phone
- (718) 583-2535
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | 024599 | NY | Primary |
Addresses
Primary practice location
1575 Bathgate Ave
Agra Pharmacy Inc
Bronx, NY 10457-8216
Mailing address
1575 Bathgate Ave
Agra Pharmacy Inc
Bronx, NY 10457-8216
Phone (718) 583-2535
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02058973 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930053586 | NY | DME Supplier - Pharmacy | 7911028089 | Practice locations: Bronx, NY |
| O20241220000508 | NY | Part B Supplier - Mass Immunization (Roster Biller Only) | 7911028089 | Practice locations: Bronx, NY |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Bronx, NY
- NPI 1255197174
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1253232000000",
"number": "1780747485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1575 BATHGATE AVE",
"address_2": "AGRA PHARMACY INC",
"city": "BRONX",
"state": "NY",
"postal_code": "104578216",
"telephone_number": "718-583-2535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 BATHGATE AVE",
"address_2": "AGRA PHARMACY INC",
"city": "BRONX",
"state": "NY",
"postal_code": "104578216",
"telephone_number": "718-583-2535"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AGRA PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-18",
"last_updated": "2009-09-18",
"status": "A",
"authorized_official_last_name": "THOMAS",
"authorized_official_first_name": "GEORGE",
"authorized_official_title_or_position": "PHARMACIST",
"authorized_official_telephone_number": "718-583-2535"
},
"taxonomies": [
{
"code": "261QC1500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Community Health",
"state": "NY",
"license": "024599",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02058973",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.