Healthcare Provider Details

I. General information

NPI: 1891263414
Provider Name (Legal Business Name): LEGACY APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W STATE HIGHWAY 5
WACONIA MN
55387-1723
US

IV. Provider business mailing address

430 W STATE HIGHWAY 5
WACONIA MN
55387-1723
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-3274
  • Fax: 952-442-3284
Mailing address:
  • Phone: 651-334-7322
  • Fax: 952-442-3284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RYAN LOEGERING
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 651-334-7322