Healthcare Provider Details

I. General information

NPI: 1023208253
Provider Name (Legal Business Name): LONGS DRUG STORES CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 WAIALO RD
ELEELE HI
96705
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 808-335-0700
  • Fax: 808-335-0755
Mailing address:
  • Phone: 401-765-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY-752
License Number StateHI

VIII. Authorized Official

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