MEDICARE: LEAGUE PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1588122154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAGUE PHARMACY LLC

Provider Business Mailing Address
First Line	:	303 E MAIN ST STE 205
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E MAIN ST STE 205
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3742
Country	:	US
Telephone Number	:	832-224-3842
Fax Number	:

Authorized Official
Title or Position	:	MANAGING OFFICER
Name	:	CHARLES JAMES
Credential	:
Telephone Number	:	832-224-3842

Provider Enumeration Date	:	03/03/2019
Last Update Date	:	07/07/2020

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