Lifetime Pharmacy Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

LIFETIME PHARMACY CORP

Practice address

23080 Alessandro Blvd
Ste 212
Moreno Valley, CA 92553-9673

Phone

(951) 656-7171

Fax

(951) 656-6363

NPI assigned

Oct 4, 2008

Organization subpart

No

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

Authorized official

Name

Ronald Vandyke

Title

Ceo

Phone

(951) 656-7171

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA3 enrollments

Enrollment records 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Locations

Practitioners 1

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

• Ada Vandyke, PHARMD

  • Pharmacist
  • Moreno Valley, CA
  • NPI 1891198719
  NPD

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

{
    "created_epoch": "1223078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1558512848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23080 ALESSANDRO BLVD",
            "address_2": "STE 212",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925539673",
            "telephone_number": "951-656-7171",
            "fax_number": "951-656-6363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23080 ALESSANDRO BLVD",
            "address_2": "STE 212",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925539673",
            "telephone_number": "951-656-7171",
            "fax_number": "951-656-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME PHARMACY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-04",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "VANDYKE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-656-7171"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6691210001",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117475",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellen Liang, DO, MPH
• Yueyi Liao
• Liberating Minds Family Therapy Services Prof. Corp
• Liberty Medical,Supply Co
• Donna Lien, MD
• Jade Liggins
• Alexander Andrew Lim, DO
• Hilary Lim, PHARMD
• Simon Christopher Lao Lim, M.D.
• Gessica Lourina Limahelu

• Community/Retail Pharmacy in Moreno Valley, CA
• Providers in Moreno Valley, 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 Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.