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General NPI Number Information
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NPI Number | 1962818625
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Entity Type | Organization
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Legal Business Name | AGS HOLDING LLC
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 8926 LEWIS AVE
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City | TEMPERANCE
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State | MI
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Zip | 48182-1607
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Country | US
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Telephone | 734-568-6688
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Fax | 734-568-6088
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Provider Business Mailing Address
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Address Line | 8926 LEWIS AVE
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City | TEMPERANCE
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State | MI
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Zip | 48182-1607
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Country | US
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Telephone | 734-568-6688
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Fax | 734-568-6088
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Authorized Official
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Title or Position | OWNER, PIC
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Name | LAP PAN CHU
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Credential | RPH
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Telephone | 419-699-5539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301010542
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License Number State | MI
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