Longs Drug Stores California LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

LONGS DRUG STORES CALIFORNIA LLC

Doing business as

CVS Pharmacy #09912

Practice address

32575 Street of the Golden Lantern
Dana Point, CA 92629

Phone

(949) 248-4803

Fax

(949) 496-7542

NPI assigned

Jun 14, 2006

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 3

Other names 1

• CVS Pharmacy #09912 Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• CVS Pharmacy Inc

  dba CVS Pharmacy #10489

  • Pharmacy
  • Fort Worth, TX
  • NPI 1265836324

  Member Of

  NPD member

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314057600000",
    "number": "1730122086",
    "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": "32575 STREET OF THE GOLDEN LANTERN",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "92629",
            "telephone_number": "949-248-4803",
            "fax_number": "949-496-7542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGS DRUG STORES CALIFORNIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2011-08-23",
        "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": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY49668",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730122086",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0598978",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "0598978",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #09912",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in Dana Point, CA
• Providers in Dana Point, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.