Provider Demographics
NPI:1174779219
Name:LONGS DRUGS OF LEXINGTON SC INC
Entity type:Organization
Organization Name:LONGS DRUGS OF LEXINGTON SC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 BOX 602683
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2683
Mailing Address - Country:US
Mailing Address - Phone:803-358-3030
Mailing Address - Fax:803-358-3034
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:2008-08-08
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0067493336C0003X
DCNRX00007893336C0003X
IL3200119823336C0003X
GAPHNR0002213336C0003X
KYSC19803336C0003X
HI12403336C0003X
FLPH292853336C0003X
ID41111MS3336C0003X
IN64002113A3336C0003X
IA46583336C0003X
CTPCN.00030173336C0003X
COOSP.00067453336C0003X
DE115973336C0003X
LAPHY.007436-NR3336C0003X
AK1080523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116693OtherPK
SC1174779219Medicaid