Provider Demographics
NPI:1013478031
Name:SIERRA VISTA PHARMACY, INC.
Entity type:Organization
Organization Name:SIERRA VISTA PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FEBY
Authorized Official - Middle Name:WILLIAM HABIB
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:559-594-8602
Mailing Address - Street 1:650 E VISALIA RD
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93223-1641
Mailing Address - Country:US
Mailing Address - Phone:559-594-8602
Mailing Address - Fax:559-594-8604
Practice Address - Street 1:650 E VISALIA RD
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:CA
Practice Address - Zip Code:93223-1641
Practice Address - Country:US
Practice Address - Phone:559-972-5551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-31
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy