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Organization
LEGACY COMPOUNDING INC
Active
Organization
LEGACY COMPOUNDING INC
Active
Other names
Legacy Compounding Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL COSTELLO BS PHARMACY (PHARMACIST-IN CHARGE)
(256) 353-1123
Entity
Organization
Contact information
Practice address
2422 DANVILLE RD SW STE H, DECATUR, AL 35603-4221
(256) 353-1123
(256) 280-3551
Mailing address
2422 DANVILLE RD SW STE H, DECATUR, AL 35603-4221
(256) 353-1123
(256) 280-3551
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
114750
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144733072
—
AL
01
—
2171878
PK
—
Enumeration date
11/14/2017
Last updated
07/19/2018
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