NPIMap

Organization Active NPI

Vista Pharmacies, Inc.

  • Pharmacy
  • Hesperia, CA
National Provider Identifier
1972658151
Registry record updated Aug 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHY48290 Issued in CA
Legal business name
VISTA PHARMACIES, INC.
Practice address
15791 Bear Valley Rd
Hesperia, CA 92345-1746
Phone
(760) 956-1741
Fax
(760) 956-1742
NPI assigned
Jan 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mike Vick
Title
Pic
Phone
(909) 908-0090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PHY48290 CA Primary
Community/Retail Pharmacy 3336C0003X PHY48290 CA

Addresses

Primary practice location

15791 Bear Valley Rd
Hesperia, CA 92345-1746

Mailing address

15791 Bear Valley Rd
Hesperia, CA 92345-1746
Phone (760) 956-1741

Other identifiers 3

IdentifierTypeStateIssuer
PHY48290OtherCALICENSE
PHA482900MedicaidCA
5625186OtherCANCPDP

Other names 1

  • Valley Vista Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Vista Pharmacies Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186963200000",
    "number": "1972658151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15791 BEAR VALLEY RD",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923451746",
            "telephone_number": "760-956-1741",
            "fax_number": "760-956-1742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15791 BEAR VALLEY RD",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923451746",
            "telephone_number": "760-956-1741",
            "fax_number": "760-956-1742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA PHARMACIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-08-13",
        "status": "A",
        "authorized_official_last_name": "VICK",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "909-908-0090"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY48290",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY48290",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PHY48290",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA482900",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5625186",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Vista Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hesperia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.