Provider Demographics
NPI:1679702211
Name:VISTA PHARMA INC
Entity Type:Organization
Organization Name:VISTA PHARMA INC
Other - Org Name:KIM AN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:PHU
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-839-5888
Mailing Address - Street 1:15550 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7570
Mailing Address - Country:US
Mailing Address - Phone:714-839-5888
Mailing Address - Fax:714-839-7788
Practice Address - Street 1:15550 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-839-5888
Practice Address - Fax:714-839-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA499440Medicaid
2120910OtherPK
6444290001Medicare NSC