Legacy Drugstore 2, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

LEGACY DRUGSTORE 2, LLC

Doing business as

Legacy Drugstore

Practice address

609 State Highway 47
Suite B
Warrenton, MO 63383

Phone

(314) 605-7340

NPI assigned

Apr 21, 2017

Last updated

Apr 21, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

LEGACY CIRCLE HOLDINGS LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Hamilton, RPH

Title

Compliance Officer

Phone

(314) 605-7340

Specialties & licenses 1

Addresses

Other names 1

• Legacy Drugstore Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mitch Graumenz, PHARM. D

  • Pharmacist
  • Maryland Heights, MO
  • NPI 1790061596
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1295260818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 STATE HIGHWAY 47",
            "address_2": "SUITE B",
            "city": "WARRENTON",
            "state": "MO",
            "postal_code": "63383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 STATE HIGHWAY 47",
            "address_2": "SUITE B",
            "city": "WARRENTON",
            "state": "MO",
            "postal_code": "63383",
            "telephone_number": "314-605-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DRUGSTORE 2, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY CIRCLE HOLDINGS LLC",
        "enumeration_date": "2017-04-21",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "314-605-7340",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Drugstore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Nicole Lapak, DDS
• Nicole Lynne Larrison, FNP
• Jonah Lasater
• Sarah Lasman, FNP
• Braden M Lawson
• Sarah Nichole Lemond, LMSW
• Heather Renee Leone, FNP-C
• Lifenet, Inc (Arch Air Medical Service, Inc)
• Kara Lippmann, COTA/L
• John Lusicic, DC

• Community/Retail Pharmacy in Warrenton, MO
• Providers in Warrenton, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.