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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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPH604HI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31203885OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1770525503
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 :
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number : 401-765-1500
Fax Number :
Provider Business Practice Location Address
First Line : 91-1401 FORT WEAVER RD
Second Line :
City : EWA BEACH
State : HI
Zip : 96706-2253
Country : US
Telephone Number : 808-685-5621
Fax Number :
Authorized Official
Title or Position : DIRECTOR PAYER RELATIONS
Name : SUSAN COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 06/13/2006
Last Update Date : 02/01/2021

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Directions to “LONGS DRUG STORES CALIFORNIA LLC ” Practice Location

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