Provider Demographics
NPI:1508488362
Name:AGM RX INC
Entity Type:Organization
Organization Name:AGM RX INC
Other - Org Name:AGM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUSINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-308-7538
Mailing Address - Street 1:12043 RIVERDSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:818-308-7538
Mailing Address - Fax:818-308-6991
Practice Address - Street 1:12043 RIVERDSIDE DR
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607
Practice Address - Country:US
Practice Address - Phone:818-308-7538
Practice Address - Fax:818-308-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57478OtherBOARD OF PHARMACY