Agm RX Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

AGM RX INC

Practice address

12043 Riverside Dr.
Valley Village, CA 91607-3744

Phone

(818) 308-7538

Fax

(818) 308-6991

NPI assigned

Jul 26, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lusine Mardyan

Title

President/Ceo/Owner

Phone

(818) 308-7538

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• AGM PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Agm RX Inc

  • Community/Retail Pharmacy
  • Valley Village, CA
  • NPI 1508488362

  O20200415000364

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory Imoohi, PHARM.D.

  • Pharmacist
  • San Bernardino, CA
  • NPI 1558598755
  NPD (past)
• Theresa Cherisse Taylor, PHARMD

  • Pharmacist
  • San Bernardino, CA
  • NPI 1861937138
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1699775205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12043 RIVERSIDE DR.",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916073744",
            "telephone_number": "818-308-7538",
            "fax_number": "818-308-6991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12043 RIVERSIDE DR.",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916073744",
            "telephone_number": "818-308-7538",
            "fax_number": "818-308-6991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGM RX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "MARDYAN",
        "authorized_official_first_name": "LUSINE",
        "authorized_official_title_or_position": "PRESIDENT/CEO/OWNER",
        "authorized_official_telephone_number": "818-308-7538",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY PERMIT",
            "identifier": "54489",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AGM PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Valley Village, CA
• Providers in Valley Village, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.