Organization
LEGACY PHARMACY, LLC
Active
Other names
LEGACY DRUG, Legacy Drug
Organization subpart
No
Provider details
NPI number
Authorized official
JULLIE JUSTICE (CONTRACTING)
(405) 447-3911
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
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200135440B
—
OK
01
—
2074447
PK
—
Enumeration date
02/22/2006
Last updated
05/06/2020
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