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NPI Code Detail

MEDICARE: LEGENDS PHARMACY III SERVICES LLC

MEDICARE: LEGENDS PHARMACY III SERVICES 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
1333600000XPharmacy
23336L0003XLong Term Care PharmacyPH00001438NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22058119OTHERPK

General Provider Information

NPI Number : 1982753232
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGENDS PHARMACY III SERVICES LLC
Provider Business Mailing Address
First Line : 6601 BLANCO RD
Second Line : SUITE 201
City : SAN ANTONIO
State : TX
Zip : 78216-6102
Country : US
Telephone Number : 210-510-2692
Fax Number : 210-736-4438
Provider Business Practice Location Address
First Line : 500 LOUISIANA BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87108-2051
Country : US
Telephone Number : 505-262-5728
Fax Number : 505-262-5779
Authorized Official
Title or Position : VP OF PHARMACY OPERATIONS
Name : DR. ANGELA PERSYN
Credential : PHARMD
Telephone Number : 210-510-2692
Provider Enumeration Date : 01/09/2007
Last Update Date : 08/30/2024

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Directions to “LEGENDS PHARMACY III SERVICES LLC ” Practice Location

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