Organization
MIRA VISTA PHARMACY PLLC
Active
Other names
MIRA VISTA APOTHECARY
Organization subpart
No
Provider details
NPI number
Authorized official
MONI SAGOO (DIRECTOR OF PHARMACY)
(817) 292-3800
Entity
Organization
Contact information
Practice address
7033 BRYANT IRVIN RD, FORT WORTH, TX 76132-4243
(817) 292-3800
(817) 292-3810
Mailing address
7033 BRYANT IRVIN RD STE 300, FORT WORTH, TX 76132-4243
(817) 292-3800
(817) 292-3810
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
26982
TX
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125635
PK
—
Enumeration date
07/01/2010
Last updated
09/19/2025
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