Organization
LEGACY MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMERON ANDRE WEATHERFORD (MANAGING PARTNER)
(224) 214-3916
Entity
Organization
Contact information
Practice address
1616 GRAND AVE STE 105, WAUKEGAN, IL 60085-3676
(847) 942-1385
Mailing address
1616 GRAND AVE STE 105, WAUKEGAN, IL 60085-3676
(847) 942-1385
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/23/2025
Last updated
05/01/2025
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