Provider Demographics
NPI:1275684987
Name:LONGS DRUGS
Entity Type:Organization
Organization Name:LONGS DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENIAK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:831-335-6403
Mailing Address - Street 1:6247 GRAHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9723
Mailing Address - Country:US
Mailing Address - Phone:831-335-6403
Mailing Address - Fax:831-335-6407
Practice Address - Street 1:6247 GRAHAM HILL RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9723
Practice Address - Country:US
Practice Address - Phone:831-335-6403
Practice Address - Fax:831-335-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0475950584Medicare ID - Type Unspecified