Longs Drug Stores California LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

49428 Issued in CA

Legal business name

LONGS DRUG STORES CALIFORNIA LLC

Doing business as

CVS Pharmacy #09847

Practice address

29985 Canyon Hills Road
Lake Elsinore, CA 92532

Phone

(951) 244-6001

Fax

(951) 244-2116

NPI assigned

Jul 3, 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 2

Other names 1

• CVS PHARMACY #09847 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.

CLIA laboratory certificates

Medicare medical equipment & supply locations

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

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Yusra Al-Dahan

  • Pharmacist
  • Lake Elsinore, CA
  • NPI 1962095018
  NPD (past)
• Linhsan Le, PHARM.D

  • Pharmacist
  • Lake Elsinore, CA
  • NPI 1982130142
  NPD (past)
• Steve McCain

  • Pharmacist
  • Lake Elsinore, CA
  • NPI 1831561257
  NPD (past)
• Lena Nam

  • Pharmacist
  • Lake Elsinore, CA
  • NPI 1154794824
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418774400000",
    "number": "1952331217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "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": "29985 CANYON HILLS ROAD",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "92532",
            "telephone_number": "951-244-6001",
            "fax_number": "951-244-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGS DRUG STORES CALIFORNIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2014-12-17",
        "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": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "49428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952331217",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5622534",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #09847",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Lee Little, RPH
• Christopher Yeong-Shyang Liu, PHARM.D.
• Brianna Michelle Llamas, RN
• Margie Lyn Logsdon, PHARMD
• Mark Joseph Lomboy
• Ally Loomer
• Logan Hurst Loomis, PA-C
• Viviana Lopez Vargas
• Alicia Lopez
• Analyz Lopez

• Community/Retail Pharmacy in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; 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.