=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740392679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R & K LOMBARD PHARMACY CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 S EL CAMINO REAL STE A
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672-4284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-492-1050
-----------------------------------------------------
Fax | 949-492-3191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 S EL CAMINO REAL STE A
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672-4284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHARMACIST
-----------------------------------------------------
Name | ROBERT LOMBARD
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 949-492-1050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY46768
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------