Healthcare Provider Details

I. General information

NPI: 1972742195
Provider Name (Legal Business Name): LEGENDS PHARMACY II, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 AVENUE D STE 500
KATY TX
77493-3646
US

IV. Provider business mailing address

6601 BLANCO ROAD SUITE 201
SAN ANTONIO TX
78216
US

V. Phone/Fax

Practice location:
  • Phone: 281-496-0640
  • Fax: 844-646-6562
Mailing address:
  • Phone: 210-510-2692
  • Fax: 210-736-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number26436
License Number StateTX

VIII. Authorized Official

Name: DR. ANGELA D DIPAOLO
Title or Position: VP OF PHARMACY OPERATIONS
Credential: RPH, PHARMD
Phone: 210-510-2692