# LONG'S DRUGSTORES OF SOUTH CAROLINA, INC.

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

## Provider details

- **NPI number:** 1548769219
- **Authorized official:** ASHLEY ELLIS (CORPORATE COUNSEL)
- **Authorized official phone:** (803) 254-5884

## Contact information

- **Practice address:** 811 PENDLETON ST STE 10, GREENVILLE, SC 29601-3232
- **Practice address phone:** (803) 254-5884
- **Practice address fax:** (866) 550-7461
- **Mailing address:** 811 PENDLETON ST STE 10, SUITE 10, GREENVILLE, SC 29601-3232
- **Mailing address phone:** (803) 254-5884
- **Mailing address fax:** (866) 550-7461

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 17623 | SC | Yes |

## Other

- **Enumeration date:** 02/07/2018
- **Last updated:** 02/07/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2175693 | PK | — |