Longs Drug Stores California LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

LONGS DRUG STORES CALIFORNIA LLC

Doing business as

CVS Pharmacy #07962

Practice address

5685 Balboa Ave
San Diego, CA 92111-2705

Phone

(858) 279-2860

Fax

(858) 279-0424

NPI assigned

Jun 13, 2006

Last updated

Aug 23, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Colbert

Title

Director, Payer Relations

Phone

(401) 770-2751

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• CVS Pharmacy #07962 Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• CVS Pharmacy Inc.

  dba CVS Pharmacy #17247

  • Pharmacy
  • North Dartmouth, MA
  • NPI 1831271071

  Member Of

  NPD member

Locations

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alexandra Awrahem, PHARMD

  • Pharmacist
  • San Diego, CA
  • NPI 1760221667
  NPD (past)
• Jennifer Dang, PHARMD

  • Pharmacist
  • San Diego, CA
  • NPI 1659812543
  NPD (past)
• Dawn Enzweiler, RPH

  • Pharmacist
  • Chula Vista, CA
  • NPI 1932507068
  NPD (past)
• James Gonzalez

  • Pharmacist
  • San Diego, CA
  • NPI 1295260792
  NPD (past)
• Megan Grigas

  • Pharmacist
  • San Diego, CA
  • NPI 1881113637
  NPD (past)
• Jane Ye-Eun Kim, PHARMD

  • Pharmacist
  • San Diego, CA
  • NPI 1003441080
  NPD (past)
• James Junsuk Lee, PHARMD

  • Pharmacist
  • San Diego, CA
  • NPI 1497213466
  NPD (past)
• Woojin Lim

  • Pharmacotherapy Pharmacist
  • San Diego, CA
  • NPI 1356059992
  NPD (past)
• Gail Renee Shifman, RPH

  • Pharmacist
  • San Diego, CA
  • NPI 1407448038
  NPD (past)
• Stephanie Wills, PHARMD

  • Community/Retail Pharmacy
  • San Diego, CA
  • NPI 1811425465
  NPD (past)
• Dasol Gloria Yoon

  • Pharmacist
  • San Diego, CA
  • NPI 1255979860
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314057600000",
    "number": "1063454882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE CVS DRIVE",
            "address_2": "BOX 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "02895",
            "telephone_number": "401-765-1500",
            "fax_number": "401-770-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5685 BALBOA AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112705",
            "telephone_number": "858-279-2860",
            "fax_number": "858-279-0424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGS DRUG STORES CALIFORNIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2011-08-23",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY49305",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0505036",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063454882",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #07962",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ivoon Longhurst
• Kimberly A. Longmire, M.D.
• Lonyael Longmire
• Javier Antonio Longoria, M.D.
• Longs Drug Stores California LLC (CVS Pharmacy #09154)
• Longs Drug Stores California LLC (CVS Pharmacy #09937)
• Longs Drug Stores California LLC (CVS Pharmacy #03914)
• Longs Drug Stores California LLC (CVS Pharmacy #09538)
• Longs Drug Stores California LLC (CVS Pharmacy #03942)
• Longs Drug Stores California LLC (CVS Pharmacy #06332)

• Pharmacy in San Diego, CA
• Providers in San Diego, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.