Organization
LONGS DRUG STORES CALIFORNIA LLC
Active
Organization
LONGS DRUG STORES CALIFORNIA LLC
Active
Other names
CVS Pharmacy #03058
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
26180 IRIS AVE, MORENO VALLEY, CA 92555-3004
(951) 601-2468
(951) 601-3721
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY49554
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669491825
—
CA
01
—
5616745
NCPDP
CA
Enumeration date
07/19/2006
Last updated
12/05/2014
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