Provider Demographics
NPI:1740802511
Name:VISTA PHARMACY LLC
Entity type:Organization
Organization Name:VISTA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:HARDIK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-707-2490
Mailing Address - Street 1:938 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-2308
Mailing Address - Country:US
Mailing Address - Phone:610-927-6566
Mailing Address - Fax:610-927-5766
Practice Address - Street 1:938 N 8TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-2308
Practice Address - Country:US
Practice Address - Phone:610-927-6566
Practice Address - Fax:610-927-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037092520001Medicaid