Provider Demographics
NPI:1174990030
Name:VISTA CARE PHARMACY INC
Entity type:Organization
Organization Name:VISTA CARE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:760-843-7000
Mailing Address - Street 1:12351 MARIPOSA RD # 11
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-6013
Mailing Address - Country:US
Mailing Address - Phone:760-843-7000
Mailing Address - Fax:760-843-7900
Practice Address - Street 1:12351 MARIPOSA RD # 11
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-6013
Practice Address - Country:US
Practice Address - Phone:760-843-7000
Practice Address - Fax:760-843-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 534783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 53478OtherBOARD OF PHARMACY LICENSE