Lido Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

LIDO PHARMACY LLC

Practice address

351 Hospital Rd Ste 107
Newport Beach, CA 92663-3503

Phone

(949) 764-6580

Fax

(949) 764-6581

NPI assigned

Mar 2, 2007

Organization subpart

No

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

Authorized official

Name

Stephen Thomas Hom, PHARM DNPI 1063847523

Title

Managing Member

Phone

(949) 764-6580

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• NEWPORT LIDO PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• La Veta Pharmacy LLC

  • Community/Retail Pharmacy
  • Orange, CA
  • NPI 1982854956

  O20120927000485

  Same enrollment
• Pacific Pharmacy Group

  • Community/Retail Pharmacy
  • Fallbrook, CA
  • NPI 1235208570

  O20120927000485

  Same enrollment
• Peachland Pharmacy, Inc.

  • Community/Retail Pharmacy
  • Newhall, CA
  • NPI 1073938114

  O20120927000485

  Same enrollment
• Peachland Pharmacy, Inc.

  • Long Term Care Pharmacy
  • Newhall, CA
  • NPI 1700952306

  O20120927000485

  Same enrollment

Locations

Practitioners 9

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

• Stephen Thomas Hom, PHARM.D.

  • Pharmacist
  • San Diego, CA
  • NPI 1063847523
  NPD Authorized official
• Austin Wagner, PHARMD

  • Pharmacist
  • Newport Beach, CA
  • NPI 1750041307
  NPD
• Patti Ames, PHARMD

  • Pharmacist
  • Newport Beach, CA
  • NPI 1942511985
  NPD (past)
• Stephen Choi, PHARM.D.

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Pasadena, CA
  • NPI 1801450754
  NPD (past)
• Charles C Kim, PHARMD

  • Pharmacist
  • Valencia, CA
  • NPI 1326299801
  NPD (past)
• Monica Krishnan, PHARM. D

  • Pharmacist
  • Saugus, CA
  • NPI 1518397462
  NPD (past)
• Eddie Kwon

  • Pharmacist
  • Saugus, CA
  • NPI 1750798633
  NPD (past)
• Gerard Rivera, PHARMD.

  • Pharmacist
  • Newport Beach, CA
  • NPI 1669847919
  NPD (past)
• Devin Omari Cohen, PHARMD

  • Pharmacist
  • Sugar Land, TX
  • NPI 1194342402
  NPD (past)

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1164550885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 HOSPITAL RD STE 107",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633503",
            "telephone_number": "949-764-6580",
            "fax_number": "949-764-6581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 HOSPITAL RD STE 107",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633503",
            "telephone_number": "949-764-6580",
            "fax_number": "949-764-6581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIDO PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "HOM",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "949-764-6580",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "PHY60035",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEWPORT LIDO PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joanna Margaret Libby, MD
• Liberty Housing Services Inc.
• Lisa Ann Licavoli, R.D.
• Jay P. Lichman, M.D.
• Amber Licona
• Lido Pharmacy LLC
• Lido Surgical Institute, LTD.
• Lido TMS Center LLC
• Lido Wellness Center
• Corey Michael Lieber, MD

• Community/Retail Pharmacy in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.