Healthcare Provider Details

I. General information

NPI: 1023011053
Provider Name (Legal Business Name): VINE DISCOUNT PHARMACY & MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 N VINE ST STE 11
LOS ANGELES CA
90038-1662
US

IV. Provider business mailing address

1253 N VINE ST SUITE #11
LOS ANGELES CA
90038-1662
US

V. Phone/Fax

Practice location:
  • Phone: 323-957-9446
  • Fax: 323-957-9846
Mailing address:
  • Phone: 323-957-9446
  • Fax: 323-957-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46506
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number46506
License Number StateCA

VIII. Authorized Official

Name: DR. ROSEANNE PAPOYAN
Title or Position: PHARMACIST-IN-CHARGE
Credential: PHARM.D.
Phone: 323-957-9446