Organization Active NPI

Agra Pharmacy Inc

  • Community Health Clinic/Center
  • Bronx, NY
National Provider Identifier
1780747485
Registry record updated Sep 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
024599 Issued in NY
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

Updated by the provider on Sep 18, 2009

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
02058973MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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 Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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.

Verify at the official NPI Registry.