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General NPI Number Information
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NPI Number | 1124060959
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Entity Type | Organization
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Legal Business Name | LONGS DRUG STORES CALIFORNIA INC
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 17495 SW FARMINGTON RD
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City | ALOHA
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State | OR
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Zip | 97007-3212
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Country | US
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Telephone | 503-848-7700
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Fax | 503-848-7810
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Provider Business Mailing Address
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Address Line | 141 N CIVIC DR
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City | WALNUT CREEK
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State | CA
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Zip | 94596-3815
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGED CARE ADMINISTRATOR
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Name | AMY HALLIDAY
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Credential |
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Telephone | 925-210-6659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 001451
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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