Organization
LONGS DRUG STORES CALIFORNIA LLC
Active
Other names
CVS Pharmacy #09130
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
175 41ST ST, OAKLAND, CA 94611-5206
(510) 658-3496
(510) 658-0772
Mailing address
ONE CVS DRIVE, BOX 1075, WOONSOCKET, RI 02895
(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
PHY49330
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0504678
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
1881638229
—
CA
Enumeration date
06/16/2006
Last updated
03/02/2012
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