Provider Demographics
NPI:1720875800
Name:VINE DISCOUNT PHARMACY & MEDICAL SUPPLY
Entity type:Organization
Organization Name:VINE DISCOUNT PHARMACY & MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:RUZANNA
Authorized Official - Last Name:PAPOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:323-957-9446
Mailing Address - Street 1:1253 VINE ST STE 11
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-1662
Mailing Address - Country:US
Mailing Address - Phone:323-957-9446
Mailing Address - Fax:323-957-9846
Practice Address - Street 1:1253 VINE ST STE 11
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-1662
Practice Address - Country:US
Practice Address - Phone:323-957-9446
Practice Address - Fax:323-957-9846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VINE DISCOUNT PHARMACY & MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy