Provider Demographics
NPI:1225054000
Name:LONGS DRUG STORES CALIFORNIA INC
Entity Type:Organization
Organization Name:LONGS DRUG STORES CALIFORNIA INC
Other - Org Name:LONGS DRUG STORE #735/NETWORK PHARMACY
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:FILE 73241
Mailing Address - Street 2:P.O. BOX 60000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:925-210-6659
Mailing Address - Fax:925-210-6606
Practice Address - Street 1:760 WASHBURN AVE
Practice Address - Street 2:#2
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3303
Practice Address - Country:US
Practice Address - Phone:951-738-1669
Practice Address - Fax:951-738-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY475683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5622332OtherNCPDP
CAPHA475680Medicaid
CAPHA475680Medicaid