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Organization
LONG'S DRUGSTORES OF SOUTH CAROLINA, INC.
Active
Organization
LONG'S DRUGSTORES OF SOUTH CAROLINA, INC.
Active
Other names
Avita Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ELLIS (CORPORATE COUNSEL)
(803) 254-5884
Entity
Organization
Contact information
Practice address
811 PENDLETON ST STE 10, GREENVILLE, SC 29601-3232
(803) 254-5884
(866) 550-7461
Mailing address
811 PENDLETON ST STE 10, SUITE 10, GREENVILLE, SC 29601-3232
(803) 254-5884
(866) 550-7461
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
17623
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175693
PK
—
Enumeration date
02/07/2018
Last updated
02/07/2018
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