Provider Demographics
NPI:1871998609
Name:LAGRASS PHARMACY CORP
Entity type:Organization
Organization Name:LAGRASS PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FRANTZ
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAGESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-377-9400
Mailing Address - Street 1:2117 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3844
Mailing Address - Country:US
Mailing Address - Phone:718-377-9400
Mailing Address - Fax:718-377-9401
Practice Address - Street 1:2117 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3844
Practice Address - Country:US
Practice Address - Phone:718-377-9400
Practice Address - Fax:718-377-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0331213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04072395Medicaid
NY04072395Medicaid