MEDICARE: AGOURA WELLNESS RX 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1982554333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGOURA WELLNESS RX INC

Provider Business Mailing Address
First Line	:	30313 CANWOOD ST STE 24
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2066
Country	:	US
Telephone Number	:	818-770-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	30313 CANWOOD ST STE 24
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2066
Country	:	US
Telephone Number	:	818-700-2300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YAKOV SULEYMANOV
Credential	:
Telephone Number	:	818-770-2300

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/17/2026

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