# LONGS DRUGSTORES OF SC INC

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

## Provider details

- **NPI number:** 1275030645
- **Authorized official:** ASHLEY ELLIS (CORPORATE COUNSEL/AO)
- **Authorized official phone:** (704) 641-7967

## Contact information

- **Practice address:** 455 LAKESHORE PKWY, ROCK HILL, SC 29730-4205
- **Practice address phone:** (803) 992-3263
- **Practice address fax:** (844) 641-3263
- **Mailing address:** 10604 COURSEY BLVD, BATON ROUGE, LA 70816
- **Mailing address phone:** (225) 236-1541
- **Mailing address fax:** (225) 663-2158

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 17812 | SC | Yes |

## Other

- **Enumeration date:** 04/11/2018
- **Last updated:** 06/27/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2177212 | PK | — |
| 05 | — | 717812 | — | SC |