Provider Demographics
NPI:1134114879
Name:Y&Y DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:Y&Y DISCOUNT PHARMACY
Other - Org Name:SUPER DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLYUSARANSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-376-8316
Mailing Address - Street 1:14618 VICTORY BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1621
Mailing Address - Country:US
Mailing Address - Phone:818-376-8316
Mailing Address - Fax:818-376-1581
Practice Address - Street 1:14618 VICTORY BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1621
Practice Address - Country:US
Practice Address - Phone:818-376-8316
Practice Address - Fax:818-376-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA445740Medicaid
CAPHA445740Medicaid