Organization
LEGACY APOTHECARY
Active
Other names
Waconia Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN LOEGERING PHARMD (PRESIDENT)
(651) 334-7322
Entity
Organization
Contact information
Practice address
430 W HIGHWAY 5, WACONIA, MN 55387-1723
(952) 442-3274
(952) 442-3284
Mailing address
430 W HIGHWAY 5, WACONIA, MN 55387-1723
(952) 442-3274
(952) 442-3284
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
264872
MN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155597
PK
—
05
—
617666200
—
MN
Enumeration date
12/21/2015
Last updated
01/08/2019
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