Provider Demographics
NPI:1750712501
Name:VISTA SPECIALTY PHARMACY
Entity type:Organization
Organization Name:VISTA SPECIALTY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MEYYAPPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-341-5728
Mailing Address - Street 1:235 W HWY 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3027
Mailing Address - Country:US
Mailing Address - Phone:352-241-6293
Mailing Address - Fax:352-989-5849
Practice Address - Street 1:235 W HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3027
Practice Address - Country:US
Practice Address - Phone:352-241-6293
Practice Address - Fax:352-989-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X, 3336L0003X
FLPH272563336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143187OtherPK