Provider Demographics
NPI:1740392679
Name:R & K LOMBARD PHARMACY CORP.
Entity Type:Organization
Organization Name:R & K LOMBARD PHARMACY CORP.
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMBARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:949-492-1050
Mailing Address - Street 1:1001 S EL CAMINO REAL STE A
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 S EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4284
Practice Address - Country:US
Practice Address - Phone:949-492-1050
Practice Address - Fax:949-492-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY467683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0595807OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA404530Medicaid
CABT9065144OtherDEA #
CA4081370001Medicare NSC