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NPI Code Detail

MEDICARE: LONGS DRUG STORES CALIFORNIA LLC

MEDICARE: LONGS DRUG STORES CALIFORNIA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
3332B00000XDurable Medical Equipment & Medical Supplies562050HI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21203885OTHERHIOTHER ID

General Provider Information

NPI Number : 1427258128
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONGS DRUG STORES CALIFORNIA LLC
Provider Business Mailing Address
First Line : 1 CVS DR
Second Line : BOX 1075
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number : 401-765-1500
Fax Number : 401-770-7108
Provider Business Practice Location Address
First Line : 91-1401 FORT WEAVER RD
Second Line :
City : EWA BEACH
State : HI
Zip : 96706-2253
Country : US
Telephone Number : 808-685-5622
Fax Number : 808-685-5566
Authorized Official
Title or Position : MANAGER PHARMACY ENROLLMENTS
Name : CRISTIANA M MAURICIO
Credential :
Telephone Number : 401-770-2937
Provider Enumeration Date : 07/20/2007
Last Update Date : 12/29/2008

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Directions to “LONGS DRUG STORES CALIFORNIA LLC ” Practice Location

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