MEDICARE: JENNIFER RENEE LEGGINS PHARMD

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	183500000X	Pharmacist	2020023771	MO

General Provider Information

NPI Number	:	1598366452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RENEE LEGGINS PHARMD

Provider Business Mailing Address
First Line	:	1433 S SAM HOUSTON BLVD
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483-2131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 S SAM HOUSTON BLVD
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483-2131
Country	:	US
Telephone Number	:	417-967-4521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	11/05/2020

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