Provider Demographics
NPI:1427074202
Name:LONGS DRUG STORE #734/NETWORK PHARMACY
Entity type:Organization
Organization Name:LONGS DRUG STORE #734/NETWORK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CUETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-210-6660
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:925-210-6660
Mailing Address - Fax:925-210-6222
Practice Address - Street 1:35758 DATE PALM DR
Practice Address - Street 2:B-5
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6653
Practice Address - Country:US
Practice Address - Phone:760-328-2115
Practice Address - Fax:760-202-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY475833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy