Provider Demographics
NPI:1568964567
Name:LONGS DRUGS OF LEXINGTON SC INC
Entity Type:Organization
Organization Name:LONGS DRUGS OF LEXINGTON SC INC
Other - Org Name:LONG'S DRUGS OF LEXINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-254-5884
Mailing Address - Street 1:PO. 602683
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260
Mailing Address - Country:US
Mailing Address - Phone:803-358-3030
Mailing Address - Fax:
Practice Address - Street 1:1216 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2453
Practice Address - Country:US
Practice Address - Phone:803-358-3030
Practice Address - Fax:803-358-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC150523336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175072OtherPK