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
—
—
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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