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LIFETIME PHARMACY CORP
NPI 1558512848
Pharmacy - Community/Retail Pharmacy in Moreno Valley, CA

Active since October 04, 2008CLIA 05D2322089 · Waiver
23080 ALESSANDRO BLVD, STE 212, MORENO VALLEY, CA 92553(951) 656-7171(951) 656-6363 Get Directions Write a Review

NPPES record last updated: March 10, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 10, 2020, Sep 9, 2019, Jan 28, 2016 (3 updates tracked since 2016).

About Lifetime Pharmacy Corp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIFETIME PHARMACY CORP (NPI 1558512848) is a healthcare organization registered as a community/retail pharmacy in Moreno Valley, California and active in the NPI registry since October 2008. The organization holds a CLIA Waiver certificate valid through April 14, 2027 and lists Ronald Vandyke, Ceo, as its authorized official.

NPPES Registry Identity

NPI1558512848
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameLIFETIME PHARMACY CORP
Location Address23080 ALESSANDRO BLVD, STE 212Moreno Valley, CA 92553-9673
Mailing Address23080 Alessandro Blvd, Ste 212Moreno Valley, CA 92553-9673 · (951) 656-7171 · Fax (951) 656-6363
Phone(951) 656-7171
Fax(951) 656-6363
Organization SubpartNo
Authorized OfficialRonald VandykeCeo · (951) 656-7171
Enumeration DateOctober 4, 2008
Last NPPES UpdateMarch 10, 20203 updates tracked since enumeration
NPPES CertifiedMarch 10, 2020
✔ NPI 1558512848 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
Definition
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.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacyTaxonomy 333600000X
23080 ALESSANDRO BLVD, Moreno Valley, CA 92553
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Other Identifiers 2

Medicaid6691210001CA
Other2117475Pk

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2322089

Lifetime Pharmacy Corp · Moreno Valley, CA
Active · expires Apr 14, 2027
CLIA Number05D2322089
Laboratory TypePharmacy
Certificate Effective DateApril 15, 2025
Certificate Expiration DateApril 14, 2027
Laboratory DirectorAda J. Vandyke
Laboratory Phone(951) 656-7171
Laboratory LocationLifetime Pharmacy Corp23080 Alessandro Blvd, #212, Moreno Valley, CA 92553
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
23 services20 patients
Influenza vaccine, inactivated 90653
The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.
15 services15 patients

Medical Equipment Supplier Medicare DMEPOS 5

Medicare supplier enrollment and the product categories Lifetime Pharmacy Corp carries, from the Medicare DMEPOS supplier directory.

Lifetime Pharmacy Corp

DMEPOS supplier · Moreno Valley, CA
✔

Accepts Medicare assignment

Lifetime Pharmacy Corp agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20420645
Medicare Participant SinceJuly 2, 2019
Supplier Location23080 Alessandro Blvd Ste 212Moreno Valley, CA 92553
Phone(951) 656-7171
Supplier Specialties
Pharmacy

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CARINA MARLEN PRIETO
Nurse Practitioner (Family)
23080 ALESSANDRO BLVD
MORENO VALLEY, CA 92553
Riverside County (951) 697-7866
HENRY NGUYEN, OD, INC.
Optometrist
23080 ALESSANDRO BLVD, SUITE 206
MORENO VALLEY, CA 92553
Riverside County (951) 656-3693
DR. HENRY NGUYEN O.D.
Optometrist
23080 ALESSANDRO BLVD, SUITE# 206
MORENO VALLEY, CA 92553
Riverside County (951) 656-3693
DR. ALFREDO PAREDES DDS
Dentist
23080 ALESSANDRO BLVD
MORENO VALLEY, CA 92553
Riverside County (951) 697-0909
ALEXANDRA TRAN
Pharmacist
23080 ALESSANDRO BLVD
MORENO VALLEY, CA 92553
Riverside County (951) 656-7171
DR. ROCIO D DEZA DDS
Dentist (General Practice)
23080 ALESSANDRO BLVD, STE 201
MORENO VALLEY, CA 92553
Riverside County (951) 697-0909
DR. KAMAL KALI HOSSAIN MD
Family Medicine
23080 ALESSANDRO BLVD, STE 202
MORENO VALLEY, CA 92553
Riverside County (951) 688-3001
SAM KHUMOORO CHIROPRACTIC PROFESSINAL CORPORATION
Chiropractor
23080 ALESSANDRO BLVD, STE. 204
MORENO VALLEY, CA 92553
Riverside County (951) 571-4090

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lifetime Pharmacy Corp's NPI number?

The NPI number for Lifetime Pharmacy Corp is 1558512848. It was assigned to this organization in the NPPES registry on October 4, 2008.

Where is Lifetime Pharmacy Corp located?

Lifetime Pharmacy Corp is located at 23080 Alessandro Blvd Ste 212, Moreno Valley, CA 92553. The listed phone number is (951) 656-7171.

What is Lifetime Pharmacy Corp's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Lifetime Pharmacy Corp accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Lifetime Pharmacy Corp accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Lifetime Pharmacy Corp hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2322089) is associated with this NPI, valid through April 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lifetime Pharmacy Corp accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 47 other insurers list Lifetime Pharmacy Corp as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lifetime Pharmacy Corp was last updated on March 10, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.