Southland Legend Pharmacy

LBN: Southland Legend Pharmacy
Southland Legend Pharmacy is an health care organization with primary practice located at 5201 S Broadway Ave Ste 100, Tyler TX 75703-3748. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Pharmacy is the primary health care specialty. Southland Legend Pharmacy can be contacted via phone (903) 534-8218, or through Benedetti, Doug via phone (903) 534-8218.

Contact Information

Primary practice address
5201 S Broadway Ave Ste 100 Tyler TX 75703-3748
Phone: (903) 534-8218
Fax: (903) 534-2897
Website:
Map and Directions
Authorized official contact:
Name: Benedetti, Doug
Phone: (903) 534-8218

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 17039 Texas
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1225142219
LBN Legal business name Southland Legend Pharmacy
DBA Doing business as
Authorized official Benedetti, Doug
Entity Organization
Organization subpart 1 No
Enumeration date Aug 18th, 2006
Last updated Aug 22nd, 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 1225142219 NPPES
Texas MEDICAID 144423
Texas Other 4572093

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