Healthcare Provider Details

I. General information

NPI: 1922648948
Provider Name (Legal Business Name): VERTEXRX PHARMACY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11273 LAUREL CANYON BLVD STE 4
SAN FERNANDO CA
91340-4359
US

IV. Provider business mailing address

11273 LAUREL CANYON BLVD STE 4
SAN FERNANDO CA
91340-4359
US

V. Phone/Fax

Practice location:
  • Phone: 818-638-9652
  • Fax: 818-638-9653
Mailing address:
  • Phone: 818-638-9652
  • Fax: 818-638-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANGEL SAMVALIAN
Title or Position: CEO
Credential:
Phone: 818-638-9652