NPIMap

Organization Active NPI

Long's Drugstores of South Carolina, Inc.

Doing business as Avita Pharmacy

  • Community/Retail Pharmacy
  • Greenville, SC
National Provider Identifier
1548769219
Registry record updated Feb 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
17623 Issued in SC
Legal business name
LONG'S DRUGSTORES OF SOUTH CAROLINA, INC.
Doing business as
Avita Pharmacy
Practice address
811 Pendleton St Ste 10
Greenville, SC 29601-3232
Phone
(803) 254-5884
Fax
(866) 550-7461
NPI assigned
Feb 7, 2018
Last updated
Feb 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2018

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

Authorized official

Name
Ashley Ellis
Title
Corporate Counsel
Phone
(803) 254-5884

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 17623 SC Primary

Addresses

Primary practice location

811 Pendleton St Ste 10
Greenville, SC 29601-3232

Mailing address

811 Pendleton St Ste 10
Suite 10
Greenville, SC 29601-3232
Phone (803) 254-5884

Other identifiers 1

IdentifierTypeStateIssuer
2175693OtherPK

Other names 1

  • Avita Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040614001381 SC Part B Supplier - Mass Immunization (Roster Biller Only) 6103800768 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rock Hill, SC; Greenville, SC; Charleston, SC
O20241126001285 SC Part B Supplier - Pharmacy 6103800768 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charleston, SC; Greenville, SC; Rock Hill, SC

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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.

Locations

1481 Tobias Gadson Blvd
Ste 2D
Charleston, SC 29407
Phone (843) 996-1496

8810 Farrow Rd
Columbia, SC 29203
Phone (803) 736-5915

811 Pendleton St
Ste 10
Greenville, SC 29601
Phone (864) 250-0607

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517961600000",
    "number": "1548769219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 PENDLETON ST STE 10",
            "address_2": "SUITE 10",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296013232",
            "telephone_number": "803-254-5884",
            "fax_number": "866-550-7461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 PENDLETON ST STE 10",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296013232",
            "telephone_number": "803-254-5884",
            "fax_number": "866-550-7461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG'S DRUGSTORES OF SOUTH CAROLINA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-07",
        "last_updated": "2018-02-07",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CORPORATE COUNSEL",
        "authorized_official_telephone_number": "803-254-5884"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "17623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2175693",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.