=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538229182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINA PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18541 SHERMAN WAY SUITE#103
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-4152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-345-6534
-----------------------------------------------------
Fax | 818-345-5983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18541 SHERMAN WAY SUITE#103
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-4152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-345-6534
-----------------------------------------------------
Fax | 818-345-5983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | MR. DOAN THAI
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 818-345-6534
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 41757
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------