NPIMap

Organization Active NPI

Lodi Memorial Hospital Association Inc

  • Community/Retail Pharmacy
  • Lodi, CA
National Provider Identifier
1003846858
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY53672 Issued in CA
Legal business name
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Practice address
2415 W Vine St
104B
Lodi, CA 95242-3731
Phone
(209) 333-3009
Fax
(209) 333-3110
NPI assigned
Jul 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Authorized official

Name
Gary Airola, BS
Title
Pic/Manager
Phone
(209) 333-3009

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X PHY53672 CA Primary

Addresses

Primary practice location

2415 W Vine St
104B
Lodi, CA 95242-3731

Mailing address

2415 W Vine St
104B
Lodi, CA 95242
Phone (209) 333-3009

Other identifiers 2

IdentifierTypeStateIssuer
2003584OtherPK
PHB367420MedicaidCA

Other names 1

  • LODI HEALTH PHARMACY WEST Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160901000634 CA Part B Supplier - Pharmacy 7618880717 Practice locations: Lodi, CA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

2415 W Vine St
Ste 104B
Lodi, CA 95242
Phone (209) 333-3009

2415 W Vine St
Ste 105
Lodi, CA 95242
Phone (209) 333-3121

2415 W Vine St
#104B
Lodi, CA 95242
Phone (209) 333-3009

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Adventist Health Lodi MemorialGalt, CA, CCN 058546 Rural health clinic Operational/Managerial Control (100%) May 16, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1003846858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 W VINE ST",
            "address_2": "104B",
            "city": "LODI",
            "state": "CA",
            "postal_code": "95242",
            "telephone_number": "209-333-3009",
            "fax_number": "209-333-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 W VINE ST",
            "address_2": "104B",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423731",
            "telephone_number": "209-333-3009",
            "fax_number": "209-333-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LODI MEMORIAL HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "AIROLA",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PIC/MANAGER",
        "authorized_official_telephone_number": "209-333-3009",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY53672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2003584",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHB367420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LODI HEALTH PHARMACY WEST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.