LONGS DRUG STORES CALIFORNIA LLC (NPI# 1669775110) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669775110 |
| Entity Type | Organization |
| Organization Name | LONGS DRUG STORES CALIFORNIA LLC |
| Other Organization Name | CVS PHARMACY #04326 |
| Practice Address |
4028 Lone Tree Way Antioch CA 94531-6209 |
| Mailing Address |
1 Cvs Dr Box 1075-pharmacy Enrollments Woonsocket RI 02895-6146 |
| Practice Telephone | 9259780276 |
| Mailing Telephone | 4017651500 |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2015-06-11 |
| Authorized Official Name | SUSAN COLBERT (DIRECTOR, PAYER RELATIONS) |
| Authorized Official Telephone | 4017702751 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP | 5639630 | 01 | |
| CA | 1669775110 | 05 |
| Other Name | Type Code |
|---|---|
| CVS Pharmacy #04326 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043869340 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 988 Halekauwila St, Honolulu, HI 96814-4013 | 2019-09-09 |
| 1205203544 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 5156 Kalanianaole Hwy, Honolulu, HI 96821-1507 | 2015-08-21 |
| 1154707537 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 2829 Ala Kalani Kaumaka St, Ste M-167, Koloa, HI 96756-8571 | 2015-08-07 |
| 1376934026 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 275 W Kaahumanu Ave # 1c01a, Kahului, HI 96732-1629 | 2015-02-16 |
| 1295123636 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 100 Hookele St, Kahului, HI 96732 | 2015-01-08 |
| 1073959144 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 841 Bishop St, Suite 105, Honolulu, HI 96813-3908 | 2013-05-16 |
| 1831447861 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 135 Kehalani Village Dr, Wailuku, HI 96793-2197 | 2012-08-23 |
| 1992062970 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 95-1077 Ainamakua Dr, Mililani, HI 96789-4252 | 2012-04-16 |
| 1144523465 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 91-919 Ft Weaver Rd Spc 106, Ewa Beach, HI 96706 | 2010-12-08 |
| 1689977001 | Longs Drug Stores California LLC | Durable Medical Equipment & Medical Supplies | 19701 Vanowen St, Winnetka, CA 91306-3927 | 2010-12-07 |
| Street Address |
4028 LONE TREE WAY |
| City | ANTIOCH |
| State | CA |
| Zip Code | 94531-6209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487263448 | Peter Kim | Pharmacist | 4028 Lone Tree Way, Antioch, CA 94531-6209 | 2020-07-27 |
| 1336791078 | Yordanos Tesfay Habtemariam | Pharmacist | 4028 Lone Tree Way, Antioch, CA 94531-6209 | 2019-07-12 |
| 1366815953 | Jennifer Drake | Pharmacist | 4028 Lone Tree Way, Antioch, CA 94531-6209 | 2015-11-04 |
| 1770956351 | Jennifer Tuyen Resto | Pharmacist | 4028 Lone Tree Way, Antioch, CA 94531-6209 | 2015-11-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902406051 | Jayden Mendoza | Behavior Technician | 4849 Lone Tree Way Suite C, Antioch, CA 94531 | 2020-10-28 |
| 1093369720 | Lorena N/a Lepezmagana I | Behavior Technician | 4856 Weler Peak Way, 4856 Wexler Peak Way, Antioch, CA 94531 | 2019-07-31 |
| 1063976538 | Donna C Martinez | Respiratory Therapist, Registered | 4509 Sand Creek Rd, Antioch, CA 94531 | 2019-01-29 |
| 1215428107 | Sierra Singharath | Behavioral Analyst | 5344 Catanzaro Way, Antioch, CA 94531 | 2018-05-25 |
| 1972005551 | Meily Samantha Reyna | Behavioral Analyst | 1858 Mount Goethe Way, Antioch, CA 94531 | 2018-02-28 |
| 1225536477 | Constance Eileen Matous | Physical Therapy Assistant | 4041 Lone Tree Way Suite # 106, Antioch, CA 94531 | 2018-01-23 |
| 1851825921 | Alexander Lim Dds Inc | Dentist | 5171 Lone Tree Way, Antioch, CA 94531 | 2017-04-17 |
| 1467831222 | Jaylan Ishac | Behavioral Analyst | 4749 Crestone Peak Ct, Antioch, CA 94531 | 2015-05-27 |
| 1164831830 | Akape Home Care Agency | Home Health | 2487 Stanford Way, Ste 1a, Antioch, CA 94531 | 2014-08-07 |
| 1679992515 | Joseph Vojtko | Ophthalmology | 4501 Sand Creek Rd Dept Of, Antioch, CA 94531 | 2014-04-08 |
| Find all providers in zip 94531 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720215916 | Kaiser Foundation Health Plan Inc | Pharmacy | 4501 Sand Creek Rd Fl 4, Antioch, CA 94531-8687 | 2009-06-16 |
| 1366464018 | Target Corporation | Pharmacy | 5330 Cane Ridge Rd, Antioch, TN 37013-3839 | 2006-07-24 |
| 1669419099 | Lucky Stores II LLC | Pharmacy | 4500 Lone Tree Way, Antioch, CA 94531-7414 | 2006-06-02 |
| 1548414642 | Kaiser Foundation Hospitals | Pharmacy | 4501 Sand Creek Rd, Flr 1 Rm 1374, Antioch, CA 94531-8687 | 2008-11-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114528940 | Kaiser Foundation Health Plan Inc | Pharmacy | 4647 Zion Ave Fl4, Rm 4825, San Diego, CA 92120-2507 | 2020-11-06 |
| 1891394128 | Scriptdash Inc | Pharmacy | 4240 Kearny Mesa Rd Ste 107, San Diego, CA 92111-3769 | 2020-10-19 |
| 1235736737 | Scriptdash Inc | Pharmacy | 2360 Qume Dr, San Jose, CA 95131-1838 | 2020-10-07 |
| 1023615150 | Kaiser Foundation Health Plan Inc | Pharmacy | 9550 Escondido Ave Fl 1, Rm 1100, Hesperia, CA 92345-9120 | 2020-10-01 |
| 1033725478 | Happy Med Inc. | Pharmacy | 210 S Grand Ave Ste 116, Glendora, CA 91741-4262 | 2020-09-21 |
| 1366058794 | Joanna Jongae Kim | Pharmacy | 1020 S Anaheim Blvd Ste 101, Anaheim, CA 92805-5807 | 2020-09-21 |
| 1114532231 | Prime Rx San Gabriel, Inc. | Pharmacy | 533 W Las Tunas Dr # 102, San Gabriel, CA 91776-1133 | 2020-09-15 |
| 1164034260 | Tin Rx At The Tower Inc. | Pharmacy | 1801 Colorado Ave Ste 300, Turlock, CA 95382-2708 | 2020-08-19 |
| 1144831702 | Cameron Michael Rehmani Seraji | Pharmacy | 10542 Villa Del Cerro, Santa Ana, CA 92705-1486 | 2020-08-16 |
| 1881204907 | Kaiser Foundation Health Plan Inc | Pharmacy | 25821 S Vermont Ave Fl 4, Rm 4049, Harbor City, CA 90710-3518 | 2020-08-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.