Longs Drug Stores California LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY49698 Issued in CA

Legal business name

LONGS DRUG STORES CALIFORNIA LLC

Doing business as

CVS Pharmacy #09635

Practice address

1550 E 14TH St
San Leandro, CA 94577-4807

Phone

(510) 351-7957

Fax

(510) 351-5901

NPI assigned

Jun 14, 2006

Last updated

Apr 16, 2015By 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 #09635 Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 6

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.

• Anna Cheng, RPH, PHARMD

  • Pharmacist
  • Alameda, CA
  • NPI 1619603412
  NPD (past)
• Rowena Feng

  • Pharmacist
  • San Leandro, CA
  • NPI 1922661446
  NPD (past)
• Cherika Sexon Garcia

  • Pharmacist
  • San Leandro, CA
  • NPI 1801634845
  NPD (past)
• Scott Kamimura, RPH

  • Pharmacist
  • San Leandro, CA
  • NPI 1609333285
  NPD (past)
• Ngoc My La, PHARMD

  • Pharmacist
  • Castro Valley, CA
  • NPI 1336512227
  NPD (past)
• Sanjay Khushal Patel, PHAM D

  • Pharmacist
  • San Leandro, CA
  • NPI 1740747526
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429142400000",
    "number": "1174566343",
    "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": "1550 E 14TH ST",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945774807",
            "telephone_number": "510-351-7957",
            "fax_number": "510-351-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGS DRUG STORES CALIFORNIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2015-04-16",
        "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": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY49698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0514465",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174566343",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #09635",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Phillip Henry Lolonis
• Arnetta Lone Chief
• Olivia Long
• Ashley Longares
• Abigail Longpre
• Longs Drug Stores California LLC (CVS Pharmacy #09876)
• Longs Drug Stores California LLC (CVS Pharmacy #09942)
• Lenae Longs
• Aiko Loo, RN, NP-C
• Jazmine Lopez Luna

• Community/Retail Pharmacy in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; 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.