Longs Drug Stores California LLC
Organization Active NPI Community/Retail Pharmacy · Ewa Beach, HI
NPI 1770525503 · NPPES record last updated Feb 1, 2021
Key facts
- NPI
- 1770525503
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PH604 (HI)
- Legal business name
- LONGS DRUG STORES CALIFORNIA LLC
- Practice address
- 91-1401 Fort Weaver Rd
Ewa Beach, HI 96706-2253 - Phone
- (808) 685-5621
- NPI assigned
- Jun 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director Payer Relations
- Phone
- (401) 770-2751
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 24
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 |
| O20100930039167 | HI | DME Supplier - Pharmacy | 1254226012 |
1 other NPI on this enrollment Practice locations: Ewa Beach, 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 | PH604 | HI | Yes |
Addresses
Primary practice location
91-1401 Fort Weaver Rd
Ewa Beach, HI 96706-2253
Mailing address
1 CVS Dr
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHA 452760 | Medicaid | HI | |
| 25319701 | Medicaid | HI | |
| 1203885 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- LONGS Drugs #09988
Other providers in Ewa Beach, HI
- Tai-Yuan David Lin
- Camelle Kaipolani Liu
- Christine Alofagia Liu
- Donald Hamilton Lockwood
- Longs Drug Stores California LLC
- Camika Lachae Lopez
- Magalita Lualua
- Catherine Cruz Lubin
- Krystle Lum
- Lynnette Kelly Lwin
All providers in Ewa Beach, 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 Feb 1, 2021. 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.