Legacy Pharm Ventures LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28554 Issued in TX

Legal business name

LEGACY PHARM VENTURES LLC

Practice address

2701 Austin Ave
Brownwood, TX 76801-5834

Phone

(325) 646-2322

Fax

(325) 646-2322

NPI assigned

May 16, 2013

Organization subpart

No

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

Authorized official

Name

Tim Jacobs

Title

Pharmacist/Owner

Phone

(325) 647-7093

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jacobs Family Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

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

• John Timothy Jacobs, R.PH.

  • Pharmacist
  • Brownwood, TX
  • NPI 1336147115
  NPD
• Susan Marie Gould, RPH

  • Pharmacist
  • Brownwood, TX
  • NPI 1487955035
  NPD (past)

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

{
    "created_epoch": "1368662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388966400000",
    "number": "1801232947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 AUSTIN AVE",
            "city": "BROWNWOOD",
            "state": "TX",
            "postal_code": "768015834",
            "telephone_number": "325-646-1100",
            "fax_number": "325-646-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 AUSTIN AVE",
            "city": "BROWNWOOD",
            "state": "TX",
            "postal_code": "768015834",
            "telephone_number": "325-646-2322",
            "fax_number": "325-646-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PHARM VENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-16",
        "last_updated": "2014-01-06",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "325-647-7093"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "28554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2138803",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacobs Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tommy La
• Charles David Lantrip
• Cameron Lee Larue, LPC
• Janice Dugi Layton, OTA
• Lee Healthcare Medical Supply LLC
• Bruce Leipzig, MD
• Stephen R Lemons, PA
• Marlinda Jo Leonard
• Jerry Dean Leslie, LCP,LMFT,LCDC
• Christian Lewis

• Community/Retail Pharmacy in Brownwood, TX
• Providers in Brownwood, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; 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.