Provider Demographics
NPI:1619218229
Name:AGS HOLDING LLC
Entity Type:Organization
Organization Name:AGS HOLDING LLC
Other - Org Name:ANSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAP PAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:419-699-5539
Mailing Address - Street 1:25684 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2019
Mailing Address - Country:US
Mailing Address - Phone:419-874-8878
Mailing Address - Fax:419-874-8898
Practice Address - Street 1:25684 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2019
Practice Address - Country:US
Practice Address - Phone:419-874-8878
Practice Address - Fax:419-874-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0223003503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139167OtherPK