MEDICARE: AMERIGEN RX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336M0003X	Managed Care Organization Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1790375772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERIGEN RX

Provider Business Mailing Address
First Line	:	1001 VIRGINIA AVE STE 360
Second Line	:
City	:	HAPEVILLE
State	:	GA
Zip	:	30354-1367
Country	:	US
Telephone Number	:	404-941-7575
Fax Number	:	404-941-7167

Provider Business Practice Location Address
First Line	:	1001 VIRGINIA AVE STE 360
Second Line	:
City	:	HAPEVILLE
State	:	GA
Zip	:	30354-1367
Country	:	US
Telephone Number	:	404-941-7575
Fax Number	:	404-941-7167

Authorized Official
Title or Position	:	MANAGER
Name	:	VU HOANG
Credential	:
Telephone Number	:	404-941-7575

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	05/18/2022

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Directions to “AMERIGEN RX ” Practice Location

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