Longs Drug Stores California, LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

LONGS DRUG STORES CALIFORNIA, LLC

Practice address

2100 Columbus Pkwy
Benicia, CA 94510

Phone

(707) 747-3453

Fax

(707) 747-6022

NPI assigned

Aug 30, 2007

Organization subpart

No

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

Authorized official

Name

Susan F Colbert

Title

Director, Payer Relations

Phone

(401) 770-2751

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• CVS Pharmacy #09761 Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

  • Pharmacy
  • Dallas, TX
  • NPI 1578667366

  Member Of

  NPD member

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Zaid Haddad

  • Pharmacist
  • Benicia, CA
  • NPI 1508420720
  NPD (past)
• Sun Mi Kim

  • Pharmacist
  • Benicia, CA
  • NPI 1083279822
  NPD (past)
• Yao Guillaume Kouassi, PHARMD

  • Pharmacist
  • Benicia, CA
  • NPI 1568053783
  NPD (past)
• Abbas Nowroozi, PHARMD

  • Pharmacist
  • Benicia, CA
  • NPI 1467282012
  NPD (past)
• Kyung Oh, PHARMACIST

  • Pharmacist
  • Albany, CA
  • NPI 1275045965
  NPD (past)
• Kristen Stedman, PHARM.D

  • Pharmacist
  • Benicia, CA
  • NPI 1801482211
  NPD (past)
• Huizhen Tsai, PHARMD

  • Pharmacist
  • Benicia, CA
  • NPI 1467988550
  NPD (past)

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314057600000",
    "number": "1679767800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "P.O. BOX 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "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": "2100 COLUMBUS PKWY",
            "city": "BENICIA",
            "state": "CA",
            "postal_code": "94510",
            "telephone_number": "707-747-3453",
            "fax_number": "707-747-6022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGS DRUG STORES CALIFORNIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-30",
        "last_updated": "2011-08-23",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "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": "PHY49701",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679767800",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5627914",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #09761",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peter Douglass Lichty, MD MOH
• Kerry L Lilley, D.C.
• Jacqueline Q Lim, DDS
• Llano Dialysis LLC
• Todd Alan Loftin, D.D.S.
• Randall Carey Lum, DDS
• Colleen Marie Macadam, MFT
• Made Whole Psychotherapy Services, Inc.
• Janice Dee Magner, MFT
• Shelly Maramonte, M. D.

• Pharmacy in Benicia, CA
• Providers in Benicia, 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.