# LEGACY APOTHECARY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waconia Clinic Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891263414
- **Authorized official:** RYAN LOEGERING PHARMD (PRESIDENT)
- **Authorized official phone:** (651) 334-7322

## Contact information

- **Practice address:** 430 W STATE HIGHWAY 5, WACONIA, MN 55387-1723
- **Practice address phone:** (952) 442-3274
- **Practice address fax:** (952) 442-3284
- **Mailing address:** 430 W STATE HIGHWAY 5, WACONIA, MN 55387-1723
- **Mailing address phone:** (651) 334-7322
- **Mailing address fax:** (952) 442-3284

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 11/13/2018
- **Last updated:** 11/13/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 617666200 | — | MN |