Organization
LEGACY DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EMILY MARIE SMITH D.PH. (PIC)
(405) 238-3305
Entity
Organization
Contact information
Practice address
111 W GRANT AVE, PAULS VALLEY, OK 73075-3257
(405) 238-3305
(405) 238-3307
Mailing address
111 W GRANT AVE, PAULS VALLEY, OK 73075-3257
(405) 238-3305
(405) 238-3307
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
22-5367
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200135440B
—
OK
Enumeration date
03/10/2009
Last updated
03/10/2009
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