Organization
LONGS DRUG STORES CALIFORNIA INC
Active
Other names
LONGS DRUG STORE NETWORK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AMY HALLIDAY (MANAGED CARE ADMINISTRATOR)
(925) 210-6659
Entity
Organization
Contact information
Practice address
12276 HESPERIA RD, VICTORVILLE, CA 92395-5838
(760) 962-8007
(760) 962-8011
Mailing address
141 N CIVIC DR, WALNUT CREEK, CA 94596-3815
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY47581
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5622180
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
PHA475810
—
CA
Enumeration date
10/13/2006
Last updated
08/22/2020
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