Provider Demographics
NPI:1821463134
Name:VISTA CARE PHARMACY INC
Entity Type:Organization
Organization Name:VISTA CARE PHARMACY INC
Other - Org Name:VISTA CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-428-1400
Mailing Address - Street 1:16055 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8053
Mailing Address - Country:US
Mailing Address - Phone:909-428-1400
Mailing Address - Fax:909-428-1500
Practice Address - Street 1:16055 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8053
Practice Address - Country:US
Practice Address - Phone:909-428-1400
Practice Address - Fax:909-428-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 537993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 53799OtherBOARD OF PHARMACY PERMIT