Organization
LEGACY DRUGSTORE LLC
Active
Other names
Legacy Drugstore
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL GRAUMENZ PHARMD (PIC)
(618) 267-0574
Entity
Organization
Contact information
Practice address
13000 VETERANS MEMORIAL PKWY, SUITE A, WRIGHT CITY, MO 63390-1041
(636) 791-1274
(636) 791-1326
Mailing address
13000 VETERANS MEMORIAL PKWY, SUITE A, WRIGHT CITY, MO 63390-1041
(636) 791-1274
(636) 791-1326
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2016040867
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2163841
PK
—
05
—
600037942
—
MO
Enumeration date
08/25/2016
Last updated
12/21/2016
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