Longs Drug Stores California LLC
Organization Active NPI Community/Retail Pharmacy · Kailua, HI
NPI 1689617854 · NPPES record last updated Mar 2, 2012
Key facts
- NPI
- 1689617854
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY242 (HI)
- Legal business name
- LONGS DRUG STORES CALIFORNIA LLC
- Practice address
- 609 Kailua Rd
Kailua, HI 96734-2816 - Phone
- (808) 261-9794
- Fax
- (808) 262-1135
- NPI assigned
- Jun 14, 2006
- 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
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 |
| O20100930052281 | HI | DME Supplier - Pharmacy | 1254226012 | Practice locations: Kailua, HI |
National Provider Directory
- Tax ID family
- Longs Drug Store 147
Locations
591 Kailua Rd
Kailua, HI 96734
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY242 | HI | Yes |
Addresses
Primary practice location
609 Kailua Rd
Kailua, HI 96734-2816
Mailing address
One CVS Drive
Box 1075
Woonsocket, RI 02895
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8271901 | Medicaid | HI | |
| 1201350 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- LONGS DRUGS #09825
Other providers in Kailua, HI
- Renata Lloyd
- Ginger D Lockette
- Jessica Lofton
- Lokahi Consulting Group, Inc
- Longs Drug Stores California LLC
- Longs Drug Stores California, Inc.
- Longs Drug Stores California, Inc.
- Regina Lopez-Merrill
- Azal Lopez
- Ramiro Loredo-Calderon
All providers in Kailua, HI · Community/Retail Pharmacy in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2012. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.