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General NPI Number Information
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NPI Number | 1972604577
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Entity Type | Organization
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Legal Business Name | VISTA PHARMACIES, INC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 15717 PARAMOUNT BLVD
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City | PARAMOUNT
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State | CA
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Zip | 90723
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Country | US
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Telephone | 562-630-8044
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Fax |
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Provider Business Mailing Address
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Address Line | 15717 PARAMOUNT BLVD
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City | PARAMOUNT
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State | CA
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Zip | 90723
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Country | US
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Telephone | 562-630-8044
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | SAN DIEM LE
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Credential | PHARMD
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Telephone | 562-630-8044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY45064
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License Number State | CA
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