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General NPI Number Information
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NPI Number | 1629296041
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Entity Type | Organization
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Legal Business Name | VISTA COMMUNITY CLINIC - PHARMACY
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 1000 VALE TERRACE DR
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City | VISTA
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State | CA
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Zip | 92084-5218
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Country | US
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Telephone | 760-631-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 VALE TERRACE DR
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City | VISTA
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State | CA
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Zip | 92084-5218
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REVENUE MANAGER
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Name | MR. TRACY MUENZ
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Credential |
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Telephone | 760-726-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PHY43164
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License Number State | CA
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