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General NPI Number Information
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NPI Number | 1295251650
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Entity Type | Organization
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Legal Business Name | LEGACY COMMUNITY HEALTH SERVICES, INC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1415 CALIFORNIA ST STE 110
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City | HOUSTON
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State | TX
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Zip | 77006-2602
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Country | US
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Telephone | 713-665-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 CALIFORNIA ST STE 110
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City | HOUSTON
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State | TX
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Zip | 77006-2602
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Country | US
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Telephone | 713-665-8800
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Fax | 713-559-3268
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Authorized Official
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Title or Position | SR VP PHARMACY & FINANCIAL SUPPORT
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Name | TRINA C LA
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Credential |
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Telephone | 832-548-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 31490
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License Number State | TX
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