Healthcare Provider Details

I. General information

NPI: 1831180926
Provider Name (Legal Business Name): A.M.G. PHARMACEUTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 ROSY FINCH LN
ALISO VIEJO CA
92656-1857
US

IV. Provider business mailing address

27 ROSY FINCH LN
ALISO VIEJO CA
92656-1857
US

V. Phone/Fax

Practice location:
  • Phone: 949-306-6582
  • Fax:
Mailing address:
  • Phone: 949-306-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2004014854
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57164
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREA MOHSEN GOMAROONI
Title or Position: PRESIDENT
Credential: PHARM.D., CH.E.
Phone: 949-306-6582