Healthcare Provider Details

I. General information

NPI: 1669596128
Provider Name (Legal Business Name): AMC RX PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W ALAMEDA AVE STE 110
BURBANK CA
91505-4815
US

IV. Provider business mailing address

2625 W ALAMEDA AVE STE 110
BURBANK CA
91505-4815
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-0423
  • Fax: 818-841-1508
Mailing address:
  • Phone: 818-841-0423
  • Fax: 818-841-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID SHALTS
Title or Position: PRESIDENT/CEO
Credential: PHARM D
Phone: 818-841-0423