NPIMap

Organization Active NPI

Legacy Compouding Inc.

  • Durable Medical Equipment & Medical Supplies
  • Decatur, AL
National Provider Identifier
1619481306
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
114750 Issued in AL
Legal business name
LEGACY COMPOUDING INC.
Practice address
2422 Danville Rd SW Ste H
Decatur, AL 35603-4221
Phone
(256) 353-1123
Fax
(256) 280-3551
NPI assigned
Nov 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Mr. Samuel Marion Costello, RPHNPI 1629120894
Title
President/Owner
Phone
(256) 353-1123

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 114750 AL Primary

Addresses

Primary practice location

2422 Danville Rd SW Ste H
Decatur, AL 35603-4221

Mailing address

2422 Danville Rd SW Ste H
Decatur, AL 35603-4221
Phone (256) 353-1123

National Provider Directory

National Provider Directory
Tax ID family
Legacy Compouding Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1510876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1619481306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 DANVILLE RD SW STE H",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356034221",
            "telephone_number": "256-353-1123",
            "fax_number": "256-280-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 DANVILLE RD SW STE H",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356034221",
            "telephone_number": "256-353-1123",
            "fax_number": "256-280-3551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY COMPOUDING INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-17",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "MARION",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "256-353-1123",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "114750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.