Provider Demographics
NPI:1528134442
Name:AMGPHARMACY INC
Entity type:Organization
Organization Name:AMGPHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-633-2291
Mailing Address - Street 1:2700 INTERNATIONAL BLVD
Mailing Address - Street 2:A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1520
Mailing Address - Country:US
Mailing Address - Phone:888-633-2291
Mailing Address - Fax:
Practice Address - Street 1:2700 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1520
Practice Address - Country:US
Practice Address - Phone:888-633-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5503220001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA470820Medicaid
CA5503220001Medicare NSC