Provider Demographics
NPI:1982003190
Name:A & G VITALIFE INC
Entity Type:Organization
Organization Name:A & G VITALIFE INC
Other - Org Name:A & G CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:747-202-3638
Mailing Address - Street 1:7233 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3006
Mailing Address - Country:US
Mailing Address - Phone:747-202-3638
Mailing Address - Fax:747-202-3639
Practice Address - Street 1:7233 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3006
Practice Address - Country:US
Practice Address - Phone:747-202-3638
Practice Address - Fax:747-202-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy