Organization
LONGS DRUG STORES CALIFORNIA LLC
Active
Other names
CVS PHARMACY #09535
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
63 LINCOLN BLVD, LINCOLN, CA 95648-9389
(916) 408-0230
(916) 408-0248
Mailing address
1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
PHY49760
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0561111
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
1447293279
—
CA
01
—
P00959574
MEDICARE - RR PIN
—
Enumeration date
06/13/2006
Last updated
12/12/2014
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