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Organization
VISTA PHARMACIES, INC
Active
Organization
VISTA PHARMACIES, INC
Active
Other names
ALTA VISTA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SAN LE PHARMD (PHARMACIST IN CHARGE)
(909) 626-4315
Entity
Organization
Contact information
Practice address
9625 MONTE VISTA AVE, STE 108, MONTCLAIR, CA 91763-2234
(909) 626-4315
Mailing address
9625 MONTE VISTA AVE, STE 108, MONTCLAIR, CA 91763-2234
(909) 626-4315
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY44318
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1989177
PK
—
05
—
PHA443180
—
CA
Enumeration date
09/12/2006
Last updated
12/20/2016
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