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General NPI Number Information
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NPI Number | 1295260818
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Entity Type | Organization
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Legal Business Name | LEGACY DRUGSTORE 2, LLC
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 609 STATE HIGHWAY 47 SUITE B
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City | WARRENTON
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State | MO
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Zip | 63383
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Country | US
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Telephone | 314-605-7340
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Fax |
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Provider Business Mailing Address
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Address Line | 609 STATE HIGHWAY 47 SUITE B
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City | WARRENTON
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State | MO
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Zip | 63383
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | JOHN HAMILTON
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Credential | RPH
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Telephone | 314-605-7340
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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 |
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License Number State |
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