MEDICARE: LONGS DRUG STORES CALIFORNIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY49456	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0548872	OTHER	OTHER ID NUMBER
2	0548872	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457395287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONGS DRUG STORES CALIFORNIA LLC

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:	P.O. BOX 1075
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:	401-765-1500
Fax Number	:	401-770-7108

Provider Business Practice Location Address
First Line	:	5644 MISSION CENTER RD
Second Line	:	STE 201
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4328
Country	:	US
Telephone Number	:	619-298-3655
Fax Number	:	619-298-6050

Authorized Official
Title or Position	:	DIRECTOR PAYER RELATIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	12/19/2014

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1881943207 — DR. MATTHEW ALLEN LEVAN PHARMD
Practice Location Address:

5644 MISSION CENTER RD
SAN DIEGO, CA
92108-4328

Practice Phone: 619-298-3655
Practice Fax: 619-298-6050

1144640293 — MS. RANDELL PAIGE SMITH FNP-BC
Practice Location Address:

5644 MISSION CENTER RD
SAN DIEGO, CA
92108-4328

Practice Phone: 908-489-6214
Practice Fax:

1477926269 — MRS. ROSALYN DELACRUZ MOHIUDDIN RPH, PHARMD.
Practice Location Address:

5644 MISSION CENTER RD
SAN DIEGO, CA
92108-4328

Practice Phone: 619-298-3655
Practice Fax: 619-298-6050

1356885651 — LAUREN LAWSON PHARMD
Practice Location Address:

5644 MISSION CENTER RD STE 201
SAN DIEGO, CA
92108-4328

Practice Phone: 619-298-3655
Practice Fax:

1629638390 — CARLOS M AYALA FNP
Practice Location Address:

5644 MISSION CENTER RD
SAN DIEGO, CA
92108-4328

Practice Phone: 619-298-3655
Practice Fax:

Directions to “LONGS DRUG STORES CALIFORNIA LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.