LIFETIME PHARMACY CORP NPI 1558512848

NPI Information

  • NPI: 1558512848
  • Provider Name: LIFETIME PHARMACY CORP
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • CLIA Number: 05D2322089
  • Address: 23080 ALESSANDRO BLVD
    STE 212
    MORENO VALLEY, CA
    ZIP 92553
  • Phone: (951) 656-7171

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NPI Details

LIFETIME PHARMACY CORP is a community/retail pharmacy pharmacy in Moreno Valley, CA. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. LIFETIME PHARMACY CORP NPI is 1558512848. The provider is registered as an organization entity type.

The provider's business location address is:

23080 ALESSANDRO BLVD
STE 212
MORENO VALLEY, CA
ZIP 92553-673
Phone: (951) 656-7171
Fax: (951) 656-6363

The provider's authorized official is Ronald Vandyke .
The authorized official title is Ceo and has the following contact phone number (951) 656-7171.

The CLIA number assigned to this NPI record is 05D2322089 - pharmacy with a certificate type of Certificate of Waiver.

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.

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

The enumeration date for this NPI number is 10/4/2008 and was last updated on 3/10/2020.

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
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2333600000XPharmacyNo
33336C0003XPharmacyCommunity/Retail 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
16691210001MEDICAIDCALIFORNIA
22117475OTHERPK

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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