WATERFRONT PHARMACY LTC LLC NPI 1114696382

NPI Information

  • NPI: 1114696382
  • Provider Name: WATERFRONT PHARMACY LTC LLC
  • Classification: Pharmacy - 3336L0003X
  • Specialization: Long Term Care Pharmacy
  • Entity Type: Organization
  • Address: 123 S COMMERCE ST STE A
    STOCKTON, CA
    ZIP 95202
  • Phone: (209) 298-1715

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NPI Details

WATERFRONT PHARMACY LTC LLC is a long term care pharmacy pharmacy in Stockton, CA. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. WATERFRONT PHARMACY LTC LLC NPI is 1114696382. The provider is registered as an organization entity type.

The provider's business location address is:

123 S COMMERCE ST STE A
STOCKTON, CA
ZIP 95202-837
Phone: (209) 298-1715
Fax: (559) 369-2408

The provider's authorized official is Chandra Kadiyala .
The authorized official title is Ceo and has the following contact phone number (509) 392-1958.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)
  • Adm sarscov2 100mcg/0.5ml3rd (HCPCS:0013A)
  • Adm sarscov2 30mcg/0.3ml 3rd (HCPCS:0003A)

The enumeration date for this NPI number is 9/9/2021 and was last updated on 4/18/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336L0003XPharmacyLong Term Care PharmacyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1PHY58030OTHERCALIFORNIAPHARMACY LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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