Provider Demographics
NPI:1922648948
Name:VERTEXRX PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:VERTEXRX PHARMACY INCORPORATED
Other - Org Name:VERTEXRX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMVALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-638-9652
Mailing Address - Street 1:11273 LAUREL CANYON BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4359
Mailing Address - Country:US
Mailing Address - Phone:818-638-9652
Mailing Address - Fax:818-638-9653
Practice Address - Street 1:11273 LAUREL CANYON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4359
Practice Address - Country:US
Practice Address - Phone:818-638-9652
Practice Address - Fax:818-638-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9307542Medicaid