Broadway Pharmacy Corporation
NPI 1104217165 · Pharmacy · Lemon Grove, CA
Enrolled with Medicare as Part B Supplier - Mass Immunization (roster Biller Only) · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Broadway Pharmacy Corporation is a Pharmacy organization in Lemon Grove, CA (NPI 1104217165).
Provider details
- NPI number
- 1104217165
- Entity type
- Organization
- Primary specialty
- PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Vincent Nguyen, Ceo/Cfo/Sec/Dir(619) 600-7246
- License
- RPH 53335 (CA)
Specialties & taxonomies
Suppliers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Broadway Pharmacy
Additional practice locations (1)
- 10225 Austin Dr Ste 103Spring Valley, CA 91978-1521Phone: (619) 825-7733Fax: (619) 825-7734
Registry dates
- Enumerated
- 2015-02-12
- Last updated
- 2025-01-27
- Certified
- 2021-01-26
Frequently asked questions
- What is Broadway Pharmacy Corporation's NPI number?
- Broadway Pharmacy Corporation's National Provider Identifier (NPI) is 1104217165, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Broadway Pharmacy Corporation?
- Broadway Pharmacy Corporation is classified in the NPPES registry as Pharmacy (Suppliers).
- Where is Broadway Pharmacy Corporation located?
- Broadway Pharmacy Corporation's practice location on file with NPPES is 7600 Pacific Ave, Lemon Grove, CA 91945.
- What is Broadway Pharmacy Corporation's phone number?
- The practice phone number listed in the NPPES registry for Broadway Pharmacy Corporation is (619) 717-8990.
- Does Broadway Pharmacy Corporation accept Medicare?
- Broadway Pharmacy Corporation is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Broadway Pharmacy Corporation?
- The authorized official listed on Broadway Pharmacy Corporation's NPPES record is Vincent Nguyen, Ceo/Cfo/Sec/Dir. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Broadway Pharmacy Corporation's NPI active?
- Yes — Broadway Pharmacy Corporation's NPI (1104217165) is active in the NPPES registry as of the last update on 2025-01-27.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.