Active NPI
Agnes Fugen
- Pharmacist
- San Fernando, CA
National Provider Identifier
1497318075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 57318
- Practice address
- 1204 San Fernando Rd
San Fernando, CA 91340-3205 - Phone
- (818) 361-2679
- NPI assigned
- Apr 18, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 57318 | CA | Primary |
Addresses
Primary practice location
1204 San Fernando Rd
San Fernando, CA 91340-3205
Mailing address
19424 Soledad Canyon Rd
Canyon Country, CA 91351-2631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57318 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients | |
| Garfield Beach CVS, L.L.C | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555545600000",
"number": "1497318075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19424 SOLEDAD CANYON RD",
"city": "CANYON COUNTRY",
"state": "CA",
"postal_code": "913512631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1204 SAN FERNANDO RD",
"city": "SAN FERNANDO",
"state": "CA",
"postal_code": "913403205",
"telephone_number": "818-361-2679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUGEN",
"first_name": "AGNES",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-18",
"last_updated": "2019-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "57318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Fernando, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.