Organization
MONTE VP LLC
Active
Other names
Monte Vista Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KYROLLOS MEKAIL (OWNER)
(951) 750-9207
Entity
Organization
Contact information
Practice address
9635 MONTE VISTA AVE STE 202, MONTCLAIR, CA 91763-2235
(909) 624-9633
(909) 624-9483
Mailing address
9635 MONTE VISTA AVE STE 202, MONTCLAIR, CA 91763-2235
(909) 624-9633
(909) 624-9483
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
PHY37394
CA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538271457
—
CA
01
—
7991760001
MEDICARE DME PTAN
—
01
—
CA514431
MEDICARE NORIDIAN PTAN MASS IMMUNIZATION ROSTER BILLER
—
Enumeration date
08/31/2006
Last updated
06/26/2022
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