LC San Diego LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY55614 Issued in CA

Legal business name

LC SAN DIEGO LLC

Doing business as

Palomar Pharmacy

Practice address

1955 Citracado Pkwy
Ste 101
Escondido, CA 92029-4110

Phone

(760) 294-0790

Fax

(760) 294-0791

NPI assigned

Oct 18, 2012

Last updated

Jul 19, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Vera Abramova

Title

Cfo

Phone

(516) 422-8477

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Palomar Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1730432469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1955 CITRACADO PKWY",
            "address_2": "STE 101",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920294110",
            "telephone_number": "760-294-0790",
            "fax_number": "760-294-0791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1955 CITRACADO PKWY",
            "address_2": "STE 101",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920294110",
            "telephone_number": "760-294-0790",
            "fax_number": "760-294-0791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LC SAN DIEGO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "ABRAMOVA",
        "authorized_official_first_name": "VERA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "516-422-8477"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY55614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730432469",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2168780",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palomar Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Linda Laverdiere, NP
• Sabina Law
• Jason Lawton
• Donald Layus, D.D.S.
• Sergio E. Lazcano
• Jeremy Le, MD
• Joy Le, RN
• Lara Le, MD
• Ryan Le
• Tra Le

• Community/Retail Pharmacy in Escondido, CA
• Providers in Escondido, 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 Jul 19, 2018; 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.