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NPI Code Detail

MEDICARE: LONGS DRUG STORES CALIFORNIA INC

MEDICARE: LONGS DRUG STORES CALIFORNIA INC
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
1333600000XPharmacyCF56115WA
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14926258OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558304816
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONGS DRUG STORES CALIFORNIA INC
Provider Business Mailing Address
First Line : 141 N CIVIC DR
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94596-3815
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3820 RAINIER AVE S
Second Line :
City : SEATTLE
State : WA
Zip : 98118-1159
Country : US
Telephone Number : 206-722-7100
Fax Number : 206-722-3901
Authorized Official
Title or Position : MANAGED CARE ADMINISTRATOR
Name : AMY HALLIDAY
Credential :
Telephone Number : 925-210-6659
Provider Enumeration Date : 06/14/2006
Last Update Date : 09/11/2025

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