# LONGS DRUGS OF LEXINGTON SC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avita Pharmacy 1051
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174779219
- **Authorized official:** ASHLEY ELLIS (CORPORATE COUNSEL)
- **Authorized official phone:** (803) 254-5884

## Contact information

- **Practice address:** 1216 W MAIN ST, LEXINGTON, SC 29072-2453
- **Practice address phone:** (803) 358-3030
- **Practice address fax:** (803) 358-3034
- **Mailing address:** PO BOX 602683, CHARLOTTE, NC 28260-2683
- **Mailing address phone:** (803) 358-3030
- **Mailing address fax:** (803) 358-3034

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 108052 | AK | Yes |
| 3336C0003X | Community/Retail Pharmacy | 11597 | DE | — |
| 3336C0003X | Community/Retail Pharmacy | 1240 | HI | — |
| 3336C0003X | Community/Retail Pharmacy | 320011982 | IL | — |
| 3336C0003X | Community/Retail Pharmacy | 41111MS | ID | — |
| 3336C0003X | Community/Retail Pharmacy | 4658 | IA | — |
| 3336C0003X | Community/Retail Pharmacy | 64002113A | IN | — |
| 3336C0003X | Community/Retail Pharmacy | NRX0000789 | DC | — |
| 3336C0003X | Community/Retail Pharmacy | OSP.0006745 | CO | — |
| 3336C0003X | Community/Retail Pharmacy | PCN.0003017 | CT | — |
| 3336C0003X | Community/Retail Pharmacy | PH29285 | FL | — |
| 3336C0003X | Community/Retail Pharmacy | PHNR000221 | GA | — |
| 3336C0003X | Community/Retail Pharmacy | PHY.007436-NR | LA | — |
| 3336C0003X | Community/Retail Pharmacy | SC1980 | KY | — |
| 3336C0003X | Community/Retail Pharmacy | Y006749 | AZ | — |

## Other

- **Enumeration date:** 08/08/2008
- **Last updated:** 05/12/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1174779219 | — | SC |
| 01 | — | 2116693 | PK | — |