MEDICARE: AMGPHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	5503220001	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528134442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMGPHARMACY INC

Provider Business Mailing Address
First Line	:	2700 INTERNATIONAL BLVD
Second Line	:	A
City	:	OAKLAND
State	:	CA
Zip	:	94601-1520
Country	:	US
Telephone Number	:	888-633-2291
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 INTERNATIONAL BLVD
Second Line	:	SUITE A
City	:	OAKLAND
State	:	CA
Zip	:	94601-1520
Country	:	US
Telephone Number	:	888-633-2291
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYUDMILA LYUSTIN
Credential	:
Telephone Number	:	888-633-2291

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	08/22/2020

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Directions to “AMGPHARMACY INC ” Practice Location

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