Healthcare Provider Details

I. General information

NPI: 1295836336
Provider Name (Legal Business Name): VISTA PHARMACIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 WHITTIER BLVD
PICO RIVERA CA
90660-2450
US

IV. Provider business mailing address

9201 WHITTIER BLVD
PICO RIVERA CA
90660-2450
US

V. Phone/Fax

Practice location:
  • Phone: 562-908-7012
  • Fax: 562-908-7014
Mailing address:
  • Phone: 562-908-7012
  • Fax: 562-908-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46204
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5600019
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerNCPDP
# 2
IdentifierPHA462040
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name: DARSHAN SATISH BHAKTA
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D.
Phone: 562-908-7012