Healthcare Provider Details

I. General information

NPI: 1730947102
Provider Name (Legal Business Name): LEGACY APOTHECARY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N COPPELL RD STE PHARMACY
COPPELL TX
75019-2293
US

IV. Provider business mailing address

PO BOX 2735
FRISCO TX
75034-0051
US

V. Phone/Fax

Practice location:
  • Phone: 972-371-0067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: RAJ MILAN CHHADUA
Title or Position: MANAGING PARTNER
Credential:
Phone: 469-294-2001