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General NPI Number Information
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NPI Number | 1023011053
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Entity Type | Organization
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Legal Business Name | VINE DISCOUNT PHARMACY & MEDICAL SUPPLY
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 1253 N VINE ST STE 11
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City | LOS ANGELES
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State | CA
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Zip | 90038-1662
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Country | US
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Telephone | 323-957-9446
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Fax | 323-957-9846
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Provider Business Mailing Address
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Address Line | 1253 N VINE ST SUITE #11
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City | LOS ANGELES
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State | CA
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Zip | 90038-1662
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Country | US
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Telephone | 323-957-9446
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Fax | 323-957-9846
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | DR. ROSEANNE PAPOYAN
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Credential | PHARM.D.
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Telephone | 323-957-9446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 46506
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY46506
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License Number State | CA
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