Healthcare Provider Details

I. General information

NPI: 1144262973
Provider Name (Legal Business Name): LONGS DRUG STORES CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W HARRIS ST STE 20
EUREKA CA
95503-3929
US

IV. Provider business mailing address

1 CVS DR P.O. BOX 1075
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-8311
  • Fax: 707-443-2784
Mailing address:
  • Phone: 401-765-1500
  • Fax: 401-770-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY49545
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN COLBERT
Title or Position: DIRECTOR /PAYER RELATIONS
Credential:
Phone: 401-770-2751