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NPI Code Detail

MEDICARE: LONGS DRUG STORES CALIFORNIA LLC

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
13336C0003XCommunity/Retail PharmacyPHY49685CA
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10556019OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619919495
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 : 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 : 12100 VENTURA BLVD
Second Line :
City : STUDIO CITY
State : CA
Zip : 91604-2514
Country : US
Telephone Number : 818-763-5562
Fax Number : 818-763-5767
Authorized Official
Title or Position : DIRECTOR, PAYER RELATIONS
Name : SUSAN F COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 06/13/2006
Last Update Date : 02/14/2011

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