Basic Information
| Provider Information | |||||||||
| NPI: | 1194925826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONGS DRUG STORES CALIFORNIA, INC. | ||||||||
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| OtherOrganizationName: | LONGS DRUG STORE #753 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 N CIVIC DR | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945963815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252106659 | ||||||||
| FaxNumber: | 9252106606 | ||||||||
| Practice Location | |||||||||
| Address1: | 16-586 OLD VOLCANO RD | ||||||||
| Address2: | |||||||||
| City: | KEAAU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967498115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088458324 | ||||||||
| FaxNumber: | 8088471142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2007 | ||||||||
| LastUpdateDate: | 07/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | HALLIDAY | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGED CARE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9252106659 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 562050 | HI | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.