Organization
LEGACY COMPOUDING INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL MARION COSTELLO RPH (PRESIDENT/OWNER)
(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
Primary
114750
AL
Other
Enumeration date
11/17/2017
Last updated
06/16/2018
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