Healthcare Provider Details

I. General information

NPI: 1447340484
Provider Name (Legal Business Name): LONGS DRUG STORES CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18182 HWY 18 STE 107
APPLE VALLEY CA
92307
US

IV. Provider business mailing address

141 N CIVIC DR
WALNUT CREEK CA
94596-3815
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-3998
  • Fax: 760-242-2926
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47580
License Number StateCA

VIII. Authorized Official

Name: AMY HALLIDAY
Title or Position: MANAGED CARE ADMINISTRATOR
Credential:
Phone: 925-210-6659