Organization
LONGS DRUGSTORES OF SC INC
Active
Other names
Avita Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ELLIS (CORPORATE COUNSEL/AO)
(704) 641-7967
Entity
Organization
Contact information
Practice address
455 LAKESHORE PKWY, ROCK HILL, SC 29730-4205
(803) 992-3263
(844) 641-3263
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816
(225) 236-1541
(225) 663-2158
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
17812
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177212
PK
—
05
—
717812
—
SC
Enumeration date
04/11/2018
Last updated
06/27/2018
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