Active NPI
Longs Drug Stores California LLC
Doing business as CVS Pharmacy #09243
- Pharmacy
- Lodi, CA
National Provider Identifier
1972546745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- LONGS DRUG STORES CALIFORNIA LLC
- Doing business as
- CVS Pharmacy #09243
- Practice address
- 1000 W Kettleman LN
Lodi, CA 95240-6054 - Phone
- (209) 368-5112
- Fax
- (209) 368-4906
- NPI assigned
- Jun 13, 2006
- Last updated
- Mar 5, 2012
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | Primary | |
| Community/Retail Pharmacy | 3336C0003X | PHY49652 | NU |
Addresses
Primary practice location
1000 W Kettleman LN
Lodi, CA 95240-6054
Mailing address
1 CVS Dr
P. O. Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972546745 | Medicaid | CA | |
| 0587379 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS Pharmacy #09243
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930014426 | CA | DME Supplier - Pharmacy | 1254226012 | Practice locations: Lodi, CA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #09243 | Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Longs Drug Store 61
Organizations with this tax ID in the same state 17
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba Longs Drug Store Network Pharmacy
- Community/Retail Pharmacy
- Victorville, CA
- NPI 1912097957
-
dba Longs Drug Store
- Community/Retail Pharmacy
- San Pablo, CA
- NPI 1912940750
-
- Pharmacy
- Merced, CA
- NPI 1952344210
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
1000 W Kettleman Ln
Lodi, CA 95240
Phone (209) 368-5112
Practitioners & affiliated clinicians
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.
-
- Pharmacist
- Lodi, CA
- NPI 1417667965
-
- Pharmacist
- Lodi, CA
- NPI 1215417647
-
- Pharmacist
- Sacramento, CA
- NPI 1932572690
-
- Pharmacist
- Lodi, CA
- NPI 1245093020
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1330905600000",
"number": "1972546745",
"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": "1000 W KETTLEMAN LN",
"city": "LODI",
"state": "CA",
"postal_code": "952406054",
"telephone_number": "209-368-5112",
"fax_number": "209-368-4906"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LONGS DRUG STORES CALIFORNIA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-13",
"last_updated": "2012-03-05",
"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": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": "PHY49652",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1972546745",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "0587379",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #09243",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; 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.