Healthcare Provider Details

I. General information

NPI: 1649295411
Provider Name (Legal Business Name): LONGS DRUG STORE #724/NETWORK PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 ARLINGTON AVE
RIVERSIDE CA
92506-3912
US

IV. Provider business mailing address

141 N CIVIC DR
WALNUT CREEK CA
94596-3815
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3653
  • Fax: 951-782-3798
Mailing address:
  • Phone: 925-210-6660
  • Fax: 925-210-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47573
License Number StateCA

VIII. Authorized Official

Name: LISA M CUETO
Title or Position: MANAGED CARE OPERATIONS MANAGER
Credential:
Phone: 925-210-6660