Provider Demographics
NPI:1336836576
Name:VISTARA COLUMBIA LLC
Entity Type:Organization
Organization Name:VISTARA COLUMBIA LLC
Other - Org Name:VISTARA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-662-5478
Mailing Address - Street 1:1120 SPARKLEBERRY LANE EXT STE D
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7078
Mailing Address - Country:US
Mailing Address - Phone:803-680-4714
Mailing Address - Fax:803-335-5158
Practice Address - Street 1:1120 SPARKLEBERRY LANE EXT STE D
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7078
Practice Address - Country:US
Practice Address - Phone:803-680-4714
Practice Address - Fax:803-335-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy