Organization
KMTV INC.
Active
Other names
Vista Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MINH DO (CEO/CFO/SEC./DIR.)
(408) 821-7425
Entity
Organization
Contact information
Practice address
825 WASHINGTON BLVD., STE. C, MONTEBELLO, CA 90640-6179
(323) 278-0016
(323) 278-0019
Mailing address
825 WASHINGTON BLVD., STE. C, MONTEBELLO, CA 90640-6179
(323) 278-0016
(323) 278-0019
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
55542
CA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427594044
—
CA
Enumeration date
05/02/2017
Last updated
04/14/2022
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