Provider Demographics
NPI:1669596128
Name:AMC RX PHARMACY, INC
Entity type:Organization
Organization Name:AMC RX PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-841-0423
Mailing Address - Street 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4815
Mailing Address - Country:US
Mailing Address - Phone:818-841-0423
Mailing Address - Fax:818-841-1508
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:STE 110
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4815
Practice Address - Country:US
Practice Address - Phone:818-841-0423
Practice Address - Fax:818-841-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Single Specialty
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58094OtherBOARD OF PHARMACY
CAPHA359370Medicaid
CAPHY35937OtherPHARMACY LICENSE
CA330374547OtherFEDERAL TAX I.D.
CA0516382OtherNCPDP
CA1562644OtherSTATE TAX I.D.