Provider Demographics
NPI:1538229182
Name:VINA PHARMACY
Entity type:Organization
Organization Name:VINA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-345-6534
Mailing Address - Street 1:18541 SHERMAN WAY
Mailing Address - Street 2:SUITE#103
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4152
Mailing Address - Country:US
Mailing Address - Phone:818-345-6534
Mailing Address - Fax:818-345-5983
Practice Address - Street 1:18541 SHERMAN WAY
Practice Address - Street 2:SUITE#103
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4152
Practice Address - Country:US
Practice Address - Phone:818-345-6534
Practice Address - Fax:818-345-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0595249OtherNABP NUMBER
CAPHY368550Medicaid
CAPHY368550Medicaid
CA4915570001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER