Legacy Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

LEGACY PHARMACY, LLC

Doing business as

Legacy Drug

Practice address

111 W Grant Ave
Pauls Valley, OK 73075-3257

Phone

(405) 238-3305

Fax

(405) 238-3307

NPI assigned

Feb 22, 2006

Last updated

May 6, 2020By 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

Jullie Justice

Title

Contracting

Phone

(405) 447-3911

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Legacy Drug Doing business as

Tax ID family

Legacy Drug2 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 Drug

  • Community/Retail Pharmacy
  • Pauls Valley, OK
  • NPI 1750522421
  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.

• Emily Smith, D.PH

  • Pharmacist
  • Pauls Valley, OK
  • NPI 1699390799
  NPD (past)

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588723200000",
    "number": "1780659755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W GRANT AVE",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730753257",
            "telephone_number": "405-238-3305",
            "fax_number": "405-238-3307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W GRANT AVE",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730753257",
            "telephone_number": "405-238-3305",
            "fax_number": "405-238-3307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "JULLIE",
        "authorized_official_title_or_position": "CONTRACTING",
        "authorized_official_telephone_number": "405-447-3911"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200135440B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2074447",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LEGACY DRUG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Legacy Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Geoffrey Ku Lau, PT, DPT
• Mattea Leann Lavin, DNP, APRN, FNP-C
• Julia Hensley Leadford, S.L.P.
• Legacy Drug
• Legacy Homecare Associates, LLC (LifeSpring Home Care)
• Cynthia Ann Lemeki
• Era Magdalena Levy, CM II, BHRS, BFA
• Lighthouse Behavioral Wellness Centers
• Lighthouse Behavioral Wellness Centers
• Bobbie Lippard

• Community/Retail Pharmacy in Pauls Valley, OK
• Providers in Pauls Valley, OK by specialty
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; 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.