Organization
LONGS DRUG STORES CALIFORNIA LLC
Active
Other names
CVS Pharmacy #09248
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1700 MCHENRY AVE, MODESTO, CA 95350-4373
(209) 529-4810
(209) 529-1019
Mailing address
ONE CVS DRIVE BOX 1075, WOONSOCKET, RI 02895
(401) 765-1500
(401) 770-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
PHY49725
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0504894
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
1053354845
—
CA
Enumeration date
06/13/2006
Last updated
02/01/2021
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