Healthcare Provider Details

I. General information

NPI: 1285677542
Provider Name (Legal Business Name): LONGS DRUG STORES CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 NE 20TH AVE STE 201
VANCOUVER WA
98686-1446
US

IV. Provider business mailing address

141 N CIVIC DR
WALNUT CREEK CA
94596-3815
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-2380
  • Fax: 360-571-2444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46146
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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