Provider Demographics
NPI:1871571307
Name:LINDA VISTA PHARMACY
Entity type:Organization
Organization Name:LINDA VISTA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:858-277-6147
Mailing Address - Street 1:2361 ULRIC ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6402
Mailing Address - Country:US
Mailing Address - Phone:858-277-6147
Mailing Address - Fax:858-277-6146
Practice Address - Street 1:2361 ULRIC ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6402
Practice Address - Country:US
Practice Address - Phone:858-277-6147
Practice Address - Fax:858-277-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA338550Medicaid
CAPHA338550Medicaid