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General NPI Number Information
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NPI Number | 1881462398
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Entity Type | Organization
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Legal Business Name | LEGACY RX
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 927 SW D AVE
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City | LAWTON
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State | OK
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Zip | 73501-4530
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Country | US
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Telephone | 580-699-8052
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Fax | 580-699-8057
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Provider Business Mailing Address
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Address Line | 927 SW D AVE
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City | LAWTON
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State | OK
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Zip | 73501-4530
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Country | US
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Telephone | 580-699-8052
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Fax | 580-699-8057
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Authorized Official
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Title or Position | PHARMACIST
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Name | HENRY THAI
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Credential | PHARMD
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Telephone | 405-924-0178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number |
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License Number State |
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