Organization
LONGS DRUG STORES CALIFORNIA LLC
Active
Other names
CVS PHARMACY #09268
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
5495 LA JOLLA BLVD, LA JOLLA, CA 92037
(858) 456-4833
(858) 456-4837
Mailing address
1 CVS DR, P.O. BOX 1075, WOONSOCKET, RI 02895-6146
(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
PHY49630
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548423601
—
CA
01
—
5630911
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/08/2008
Last updated
08/23/2011
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