Healthcare Provider Details

I. General information

NPI: 1164741377
Provider Name (Legal Business Name): LEGACY INFUSION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9969 CINCINNATI DAYTON RD
WEST CHESTER OH
45069-3823
US

IV. Provider business mailing address

1700 EDISON DR SUITE 300
MILFORD OH
45150-2729
US

V. Phone/Fax

Practice location:
  • Phone: 937-384-3873
  • Fax: 513-942-2846
Mailing address:
  • Phone: 513-576-0262
  • Fax: 513-576-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number022051200
License Number StateOH

VIII. Authorized Official

Name: MR. WILLIAM S. HERDTNER
Title or Position: VP, FINANCE AND CFO
Credential:
Phone: 513-576-0262