Organization
VISTA PHARMACIES, INC.
Active
Other names
Valley Vista Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE VICK (PIC)
(909) 908-0090
Entity
Organization
Contact information
Practice address
15791 BEAR VALLEY RD, HESPERIA, CA 92345-1746
(760) 956-1741
(760) 956-1742
Mailing address
15791 BEAR VALLEY RD, HESPERIA, CA 92345-1746
(760) 956-1741
(760) 956-1742
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHY48290
CA
3336C0003X
Community/Retail Pharmacy
PHY48290
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5625186
NCPDP
CA
05
—
PHA482900
—
CA
01
—
PHY48290
LICENSE
CA
Enumeration date
01/25/2007
Last updated
08/13/2007
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