Basic Information
| Provider Information | |||||||||
| NPI: | 1336399070 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LONGS DRUG STORES CALIFORNIA INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LONGS DRUG STORE #767 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 73241 | ||||||||
| Address2: | P.O. BOX 60000 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252106659 | ||||||||
| FaxNumber: | 9252106606 | ||||||||
| Practice Location | |||||||||
| Address1: | 2464 WINGFIELD HILLS RD | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756262436 | ||||||||
| FaxNumber: | 7756262440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2008 | ||||||||
| LastUpdateDate: | 09/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | HALLIDAY | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGED CARE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9252106659 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.