Organization Active NPI

Vons Companies Inc

  • Community/Retail Pharmacy
  • Glendale, CA
National Provider Identifier
1891721676
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY52125 Issued in CA
Legal business name
VONS COMPANIES INC
Practice address
311 W Los Feliz Rd
Glendale, CA 91204-2513
Phone
(818) 246-8189
Fax
(818) 246-0122
NPI assigned
Jun 24, 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
Demond Hawkins, CPHT MBA
Title
Third Party Manager
Phone
(208) 395-3905

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY52125 CA Primary

Addresses

Primary practice location

311 W Los Feliz Rd
Glendale, CA 91204-2513

Mailing address

250 E Parkcenter Blvd
Mailstop Sec 2-B
Boise, ID 83706-3940
Phone (208) 395-6200

Other identifiers 2

IdentifierTypeStateIssuer
1891721676MedicaidCA
1999920OtherPK

Other names 1

  • VONS PHARMACY #2254 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040831001282 TX Part B Supplier - Centralized Flu Biller 2961314463 This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID
O20100930078669 CA DME Supplier - PharmacyDME Supplier - Grocery Store 2961314463 Practice locations: Glendale, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2056248Vons Pharmacy #2254311 W Los Feliz Road, Glendale, CA 91204Certificate of waiverMar 24, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Vons Pharmacy #2254311 W Los Feliz Rd, Glendale, CA 91204-2513(818) 246-8189 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Surgical Dressings Does not accept assignmentParticipating since Jan 1, 2017

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

311 W Los Feliz Rd
Glendale, CA 91204
Phone (818) 246-7161

Practitioners & affiliated clinicians

Practitioners 2

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": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1891721676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "address_2": "MAILSTOP SEC 2-B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063940",
            "telephone_number": "208-395-6200",
            "fax_number": "623-282-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W LOS FELIZ RD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042513",
            "telephone_number": "818-246-8189",
            "fax_number": "818-246-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VONS COMPANIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "DEMOND",
        "authorized_official_title_or_position": "THIRD PARTY MANAGER",
        "authorized_official_telephone_number": "208-395-3905",
        "authorized_official_credential": "CPHT MBA"
    },
    "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": "CA",
            "license": "PHY52125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891721676",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1999920",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VONS PHARMACY #2254",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VONS PHARMACY #2254",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, CA

Sources for this page

  • 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.
  • 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.