Healthcare Provider Details

I. General information

NPI: 1740802511
Provider Name (Legal Business Name): VISTA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 N 8TH ST
READING PA
19604-2308
US

IV. Provider business mailing address

938 N 8TH ST
READING PA
19604-2308
US

V. Phone/Fax

Practice location:
  • Phone: 610-927-6566
  • Fax: 610-927-5766
Mailing address:
  • Phone: 610-927-6566
  • Fax: 610-927-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1037092520001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: HARDIK PATEL
Title or Position: PIC
Credential:
Phone: 484-707-2490