Broadway Pharmacy Corporation
NPI 1104217165ActiveOrganization· Pharmacy· Lemon Grove, CA
Pharmacy in Lemon Grove, California, registered in NPPES in February 2015. The authorized official on file is Vincent T. Nguyen, PHARM.D, Ceo/Cfo/Sec/Dir. Enrolled in Medicare as part b supplier - mass immunization (roster biller only).
Overview
| NPI | 1104217165 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 12, 2015 |
| Last updated in NPPES | Jan 27, 2025 |
| Certified by provider | Jan 26, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy Primary | 333600000X | RPH 53335 | CA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Mass Immunization (Roster Biller Only) (CA) |
|---|
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