Longs Drug Stores California LLC
Organization Active NPI Community/Retail Pharmacy · Aiea, HI
NPI 1700828522 · NPPES record last updated Nov 16, 2010
Key facts
- NPI
- 1700828522
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY228 (HI)
- Legal business name
- LONGS DRUG STORES CALIFORNIA LLC
- Practice address
- 98 1005 Moanalua Rd SPC 400
Aiea, HI 96701 - Phone
- (808) 488-0958
- Fax
- (808) 484-0857
- NPI assigned
- Jun 13, 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 |
| O20100930039501 | HI | DME Supplier - Pharmacy | 1254226012 | Practice locations: Aiea, HI |
National Provider Directory
- Tax ID family
- Longs Drug Store 147
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY228 | HI | Yes |
Addresses
Primary practice location
98 1005 Moanalua Rd SPC 400
Aiea, HI 96701
Mailing address
PO Box 1075
Woonsocket, RI 02895-0803
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1201184 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 8267501 | Medicaid | HI |
Other names
- LONGS DRUGS #09813
Other providers in Aiea, HI
- Sarah Lockwood-Sepulveda
- Carina Loe
- Lokahi Counseling Center
- Ciera Loncaric
- Longs Drug Stores California Inc
- Longs Drug Stores California, Inc.
- Russell Mun Yu Loo
- Kimberly Ann Loomis
- Indira Lopez-Ruiz
- Julia Florencia Loretto
All providers in Aiea, 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 Nov 16, 2010. 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.