Provider Demographics
NPI:1316390552
Name:TRUE VINE PHARMACY INC
Entity Type:Organization
Organization Name:TRUE VINE PHARMACY INC
Other - Org Name:CAL MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/CFO/SECRETARY/DIRECTO
Authorized Official - Prefix:
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:ABDELNOUR
Authorized Official - Last Name:ABDELMESSIH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:562-513-3012
Mailing Address - Street 1:1598 LONG BEACH BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2384
Mailing Address - Country:US
Mailing Address - Phone:562-513-3012
Mailing Address - Fax:562-513-3011
Practice Address - Street 1:1598 LONG BEACH BLVD
Practice Address - Street 2:STE 102
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2384
Practice Address - Country:US
Practice Address - Phone:562-513-3012
Practice Address - Fax:562-513-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
CAPHY544793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160946OtherPK