Provider Demographics
NPI:1003013939
Name:LONGS DRUG STORES CALIFORNIA, INC.
Entity Type:Organization
Organization Name:LONGS DRUG STORES CALIFORNIA, INC.
Other - Org Name:LONGS DRUG STORE #164
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-210-6659
Mailing Address - Street 1:141 N CIVIC DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3815
Mailing Address - Country:US
Mailing Address - Phone:925-210-6659
Mailing Address - Fax:925-210-6606
Practice Address - Street 1:3221 WAIALAE AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5842
Practice Address - Country:US
Practice Address - Phone:808-735-2811
Practice Address - Fax:808-735-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI562050332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies