Organization
BUENA VISTA PHARMACY
Active
Other names
BUENA VISTA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY GAINES (CEO)
(800) 583-0058
Entity
Organization
Contact information
Practice address
24007 VENTURA BLVD, STE 240, CALABASAS, CA 91302-1458
(800) 583-0058
(800) 921-4811
Mailing address
23679 CALABASAS RD, SUITE 800, CALABASAS, CA 91302-1502
(800) 583-0058
(800) 921-4811
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
Primary
47358
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5614436
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/19/2007
Last updated
03/22/2011
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