Organization
LONGS DRUG STORES CALIFORNIA, LLC
Active
Other names
CVS PHARMACY #04291
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
12058 PALMDALE RD, ADELANTO, CA 92301
(760) 246-2803
(760) 246-2807
Mailing address
1 CVS DR, P.O. BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY49524
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346323482
—
CA
01
—
5624223
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
08/24/2011
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