Healthcare Provider Details

I. General information

NPI: 1235812587
Provider Name (Legal Business Name): LONGS DRUGS OF LEXINGTON SC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5064 RIVERS AVE STE 201
NORTH CHARLESTON SC
29406-6304
US

IV. Provider business mailing address

10604 COURSEY BLVD
BATON ROUGE LA
70816-4015
US

V. Phone/Fax

Practice location:
  • Phone: 864-990-0242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CARL CODY COLQUITT
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 469-850-6930