NPIMap

Organization Active NPI

Longs Drugstores of SC Inc

Doing business as Longs Medical Park Pharmacy

  • Community/Retail Pharmacy
  • Columbia, SC
National Provider Identifier
1053403964
Registry record updated Mar 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
15059 Issued in SC
Legal business name
LONGS DRUGSTORES OF SC INC
Doing business as
Longs Medical Park Pharmacy
Practice address
115 Blarney Dr Ste 105
Suite 105
Columbia, SC 29223-6291
Phone
(803) 788-9608
Fax
(803) 788-7170
NPI assigned
Sep 28, 2006
Last updated
Mar 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marshall Frost
Title
Director of Business Dev
Phone
(404) 583-6945

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 15059 SC Primary

Addresses

Primary practice location

115 Blarney Dr Ste 105
Suite 105
Columbia, SC 29223-6291

Mailing address

PO Box 602688
Charlotte, NC 28260-2688
Phone (803) 788-9608

Other identifiers 2

IdentifierTypeStateIssuer
2089902OtherPK
1053403964MedicaidSC

Other names 1

  • LONGS MEDICAL PARK PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Long's Drugstores of South Carolina Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1053403964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602688",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602688",
            "telephone_number": "803-788-9608",
            "fax_number": "803-788-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 BLARNEY DR STE 105",
            "address_2": "SUITE 105",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236291",
            "telephone_number": "803-788-9608",
            "fax_number": "803-788-7170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGS DRUGSTORES OF SC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "FROST",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS DEV",
        "authorized_official_telephone_number": "404-583-6945"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "15059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2089902",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053403964",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LONGS MEDICAL PARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.