Longs Drug Stores California LLC
Organization Active NPI Pharmacy · Hauula, HI
NPI 1609210673 · NPPES record last updated Nov 12, 2013
Key facts
- NPI
- 1609210673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- PHY-839 (HI)
- Legal business name
- LONGS DRUG STORES CALIFORNIA LLC
- Practice address
- 54-316 Kamehameha Hwy
Hauula, HI 96717-9539 - Phone
- (808) 293-9091
- NPI assigned
- Apr 22, 2013
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Longs Drugs #10153 |
Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in HI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100907000987 | HI | Part B Supplier - Mass Immunization (Roster Biller Only) | 1254226012 | This NPI is an additional NPI on the enrollment |
| O20130823001133 | HI | DME Supplier - Pharmacy | 1254226012 | Practice locations: Hauula, HI |
National Provider Directory
- Tax ID family
- Longs Drug Store 147
Locations
54-316 Kamehameha Hwy
Hauula, HI 96717
Phone (808) 293-9091
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | PHY-839 | HI | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
54-316 Kamehameha Hwy
Hauula, HI 96717-9539
Mailing address
1 CVS Dr
Box 1075 Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 740367 | Medicaid | HI | |
| 1241102 | Other | NCPDP |
Other names
- LONGS DRUGS #10153
Other providers in Hauula, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.