Healthcare Provider Details

I. General information

NPI: 1063657690
Provider Name (Legal Business Name): AMER RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 BURTON MESA BLVD SUITE A
LOMPOC CA
93436-1400
US

IV. Provider business mailing address

191 BURTON MESA BLVD SUITE A
LOMPOC CA
93436-1400
US

V. Phone/Fax

Practice location:
  • Phone: 805-733-2060
  • Fax: 805-733-2061
Mailing address:
  • Phone: 805-733-2060
  • Fax: 805-733-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number029968
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH22628
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number49116
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2118100
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: AMRO AMER
Title or Position: OWNER
Credential:
Phone: 805-733-2060