Legacy Drug

LBN: Legacy Pharmacy, Llc
Legacy Drug is an health care organization with primary practice located at 111 W Grant Ave , Pauls Valley OK 73075-3257. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Legacy Pharmacy, Llc can be contacted via phone (405) 238-3305, or through Justice, Jullie via phone (405) 447-3911.

Contact Information

Primary practice address
111 W Grant Ave Pauls Valley OK 73075-3257
Phone: (405) 238-3305
Fax: (405) 238-3307
Website:
Map and Directions
Authorized official contact:
Name: Justice, Jullie
Phone: (405) 447-3911

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X
Suppliers / Compounding Pharmacy 3336C0004X

Profile Details

NPI number 1780659755
LBN Legal business name Legacy Pharmacy, Llc
DBA Doing business as Legacy Drug
Authorized official Justice, Jullie
Entity Organization
Organization subpart 1 No
Enumeration date Feb 22nd, 2006
Last updated May 6th, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780659755 NPPES
Other 2074447 PK
MEDICAID 200135440B PK

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