Healthcare Provider Details

I. General information

NPI: 1376300368
Provider Name (Legal Business Name): LEGENDS PHARMACY III SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 BLANCO RD STE 125
SAN ANTONIO TX
78216-6105
US

IV. Provider business mailing address

6601 BLANCO RD STE 201
SAN ANTONIO TX
78216-6105
US

V. Phone/Fax

Practice location:
  • Phone: 210-735-2323
  • Fax: 210-735-2324
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 Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA PERSYN
Title or Position: VP OF OPERATIONS
Credential: PHARMD
Phone: 210-842-5274