MEDICARE: VERMONT PHARMACY & MEDICAL SUPPLIES 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY48275	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0513538	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1407921083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERMONT PHARMACY & MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	1012 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2620
Country	:	US
Telephone Number	:	323-665-4465
Fax Number	:	323-665-7365

Provider Business Practice Location Address
First Line	:	1012 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2620
Country	:	US
Telephone Number	:	323-665-4465
Fax Number	:	323-665-7365

Authorized Official
Title or Position	:	PRESIDENT/ OWNER
Name	:	MR. ARMEN GRIGORIAN
Credential	:
Telephone Number	:	323-665-4465

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	11/05/2008

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