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Longs Drug Stores California LLC

Organization Active NPI Pharmacy · Mililani, HI

NPI 1992062970 · NPPES record last updated Dec 26, 2012

Key facts

NPI
1992062970
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
Legal business name
LONGS DRUG STORES CALIFORNIA LLC
Practice address
95-1077 Ainamakua Dr
Mililani, HI 96789-4252
Phone
(808) 626-2380
NPI assigned
Apr 16, 2012
Organization subpart
No

Authorized official

Name
Susan Colbert
Title
Director Payer Relations
Phone
(401) 765-1500

Corporate family (same tax ID) 12

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Longs Drugs #04405
95-1077 Ainamakua Dr, Mililani, HI 96789-4252 · (808) 626-2380		 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
Participating since Jan 1, 2025

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in HI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100907000987 HI Part B Supplier - Mass Immunization (Roster Biller Only) 1254226012 This NPI is an additional NPI on the enrollment
O20120823000678 HI DME Supplier - Pharmacy 1254226012 Practice locations: Mililani, HI

National Provider Directory

Tax ID family
Longs Drug Store 147 (275 organizations share this tax ID)

Locations

95-1077 Ainamakua Dr
Mililani, HI 96789
Phone (808) 626-2380

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

95-1077 Ainamakua Dr
Mililani, HI 96789-4252

Mailing address

1 CVS Dr
Box 1075 Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers

IdentifierTypeStateIssuer
1240845OtherNCPDP
726474MedicaidHI

Other names

  • LONGS DRUGS #04405 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 26, 2012.

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356480000000",
    "number": "1992062970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "BOX 1075 PHARMACY ENROLLMENTS",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95-1077 AINAMAKUA DR",
            "city": "MILILANI",
            "state": "HI",
            "postal_code": "967894252",
            "telephone_number": "808-626-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGS DRUG STORES CALIFORNIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-16",
        "last_updated": "2012-12-26",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR PAYER RELATIONS",
        "authorized_official_telephone_number": "401-765-1500"
    },
    "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": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1240845",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "726474",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LONGS DRUGS #04405",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mililani, HI

All providers in Mililani, HI · Pharmacy in Hawaii

Sources for this page

Verify at the official NPI Registry.