Organization
LONGS DRUG STORES CALIFORNIA LLC
Active
Other names
CVS Pharmacy #03908
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1885 W 11TH ST, TRACY, CA 95376-3727
(209) 836-1460
(209) 836-9809
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
PHY49541
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0578293
NCPDP
CA
05
—
1609898899
—
CA
Enumeration date
07/24/2006
Last updated
08/23/2011
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