Provider Demographics
NPI:1033114806
Name:AMIS PHARMACY CORPORATION
Entity Type:Organization
Organization Name:AMIS PHARMACY CORPORATION
Other - Org Name:MCINTOSH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:SON
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:760-347-3577
Mailing Address - Street 1:82422 MILES AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4250
Mailing Address - Country:US
Mailing Address - Phone:760-347-3577
Mailing Address - Fax:760-342-4458
Practice Address - Street 1:82422 MILES AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4250
Practice Address - Country:US
Practice Address - Phone:760-347-3577
Practice Address - Fax:760-342-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY483603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA483600Medicaid
0507218OtherNABP
CAPHA483600Medicaid