Provider Demographics
NPI:1427134717
Name:VISTA DRUG
Entity type:Organization
Organization Name:VISTA DRUG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-642-4500
Mailing Address - Street 1:821 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3518
Mailing Address - Country:US
Mailing Address - Phone:949-642-4500
Mailing Address - Fax:
Practice Address - Street 1:821 W 19TH ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3518
Practice Address - Country:US
Practice Address - Phone:949-642-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0588787OtherNABP
CAPHY339360OtherPHARMACY LIC #
CA0588787OtherNABP