Provider Demographics
NPI:1013369842
Name:ALLEGIANCE HEALTHCARE GROUP INC
Entity Type:Organization
Organization Name:ALLEGIANCE HEALTHCARE GROUP INC
Other - Org Name:ALLEGIANCE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NARE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-570-2002
Mailing Address - Street 1:18455 BURBANK BLVD
Mailing Address - Street 2:STE 311
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2803
Mailing Address - Country:US
Mailing Address - Phone:818-570-2002
Mailing Address - Fax:818-570-2003
Practice Address - Street 1:18455 BURBANK BLVD
Practice Address - Street 2:STE 311
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2803
Practice Address - Country:US
Practice Address - Phone:818-570-2002
Practice Address - Fax:818-570-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy