Organization
SOUTHLAND LEGEND PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG BENEDETTI (PIC)
(903) 534-8218
Entity
Organization
Contact information
Practice address
5201 S BROADWAY AVE, STE 100, TYLER, TX 75703-3748
(903) 534-8218
(903) 534-2897
Mailing address
5201 S BROADWAY AVE, STE 100, TYLER, TX 75703-3748
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
17039
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144423
—
TX
01
—
4572093
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/18/2006
Last updated
09/11/2025
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