Healthcare Provider Details

I. General information

NPI: 1053403964
Provider Name (Legal Business Name): LONGS DRUGSTORES OF SC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BLARNEY DR STE 105 SUITE 105
COLUMBIA SC
29223-6291
US

IV. Provider business mailing address

PO BOX 602688
CHARLOTTE NC
28260-2688
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-9608
  • Fax: 803-788-7170
Mailing address:
  • Phone: 803-788-9608
  • Fax: 803-788-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number15059
License Number StateSC

VIII. Authorized Official

Name: MARSHALL FROST
Title or Position: DIRECTOR OF BUSINESS DEV
Credential:
Phone: 404-583-6945