1568964567 NPI number — LONGS DRUGS OF LEXINGTON SC INC

Table of content: (NPI 1568964567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568964567 NPI number — LONGS DRUGS OF LEXINGTON SC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONGS DRUGS OF LEXINGTON SC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568964567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO. 602683
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-358-3030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1216 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29072-2453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-358-3030
Provider Business Practice Location Address Fax Number:
803-358-3034
Provider Enumeration Date:
03/06/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE COUNSEL
Authorized Official Telephone Number:
803-254-5884

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 15052 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2175072 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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