Provider Demographics
NPI:1477693729
Name:LONG POINT PHARMACY
Entity Type:Organization
Organization Name:LONG POINT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BETHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-884-8806
Mailing Address - Street 1:616 LONG POINT RD
Mailing Address - Street 2:UNIT H
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8222
Mailing Address - Country:US
Mailing Address - Phone:843-884-8806
Mailing Address - Fax:843-884-1253
Practice Address - Street 1:616 LONG POINT RD
Practice Address - Street 2:UNIT H
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8222
Practice Address - Country:US
Practice Address - Phone:843-884-8806
Practice Address - Fax:843-884-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50006597332B00000X
SCBL77533313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5006597OtherSC PHARMACY PERMIT
SC765977Medicaid
SC1006597OtherSC STATE CONT. SUBST ACT
4224060OtherNCPDP
4224060OtherNCPDP
SC1006597OtherSC STATE CONT. SUBST ACT