Legacy Apothecary

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

264872 Issued in MN

Legal business name

LEGACY APOTHECARY

Doing business as

Waconia Clinic Pharmacy

Practice address

430 W Highway 5
Waconia, MN 55387-1723

Phone

(952) 442-3274

Fax

(952) 442-3284

NPI assigned

Dec 21, 2015

Last updated

Jan 8, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ryan Loegering, PHARMDNPI 1366823882

Title

President

Phone

(651) 334-7322

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Waconia Clinic Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

Tax ID family

Legacy Apothecary2 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.

• Legacy Apothecary

  dba Waconia Clinic Pharmacy

  • Long Term Care Pharmacy
  • Waconia, MN
  • NPI 1891263414
  NPD tax ID

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.

• Ryan Loegering, PHARMD

  • Pharmacist
  • Waconia, MN
  • NPI 1366823882
  Authorized official Same address or phone

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

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546905600000",
    "number": "1669837530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 W HIGHWAY 5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871723",
            "telephone_number": "952-442-3274",
            "fax_number": "952-442-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 W HIGHWAY 5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871723",
            "telephone_number": "952-442-3274",
            "fax_number": "952-442-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY APOTHECARY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-21",
        "last_updated": "2019-01-08",
        "status": "A",
        "authorized_official_last_name": "LOEGERING",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-334-7322",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "264872",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2155597",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "617666200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waconia Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Waconia Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tamara Lynn Larsen, PT
• Barrett Paul Larson II, M.D.
• David Larson, M.D.
• Jonathan M Larson, M.D.
• Lisa Larson, M.D.
• Legacy Apothecary (Waconia Clinic Pharmacy)
• Emma Leirdahl, MD
• Sean Deane Lejonvarn, CNP
• Ashley Elizabeth Artmann Leland, PHARM.D.
• Amy M Leonard, R.D.

• Community/Retail Pharmacy in Waconia, MN
• Providers in Waconia, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; 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.