Healthcare Provider Details

I. General information

NPI: 1124112479
Provider Name (Legal Business Name): LONGS DRUGSTORES OF SC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8810 FARROW RD STE C
COLUMBIA SC
29203-8802
US

IV. Provider business mailing address

PO BOX 602680
CHARLOTTE NC
28260-2680
US

V. Phone/Fax

Practice location:
  • Phone: 803-736-5975
  • Fax: 803-419-7333
Mailing address:
  • Phone: 803-736-5975
  • Fax: 803-419-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number15056
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11840
License Number StateNC

VIII. Authorized Official

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