Organization
MIRA VISTA PHARMACY PLLC
Active
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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