NPIMap

Organization Active NPI

Legacy Apothecary

Doing business as Waconia Clinic Pharmacy

  • Long Term Care Pharmacy
  • Waconia, MN
National Provider Identifier
1891263414
Registry record updated Nov 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
LEGACY APOTHECARY
Doing business as
Waconia Clinic Pharmacy
Practice address
430 W State Highway 5
Waconia, MN 55387-1723
Phone
(952) 442-3274
Fax
(952) 442-3284
NPI assigned
Nov 13, 2018
Last updated
Nov 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2018

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

430 W State Highway 5
Waconia, MN 55387-1723

Mailing address

430 W State Highway 5
Waconia, MN 55387-1723
Phone (651) 334-7322

Other identifiers 1

IdentifierTypeStateIssuer
617666200MedicaidMN

Other names 1

  • Waconia Clinic Pharmacy Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Waconia Clinic Pharmacy430 W State Highway 5, Waconia, MN 55387-1723(952) 442-3274 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Enteral Nutrients|Nebulizer Equipment and/or Supplies|Surgical Dressings Does not accept assignmentParticipating since Aug 1, 2016

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542067200000",
    "number": "1891263414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 W STATE HIGHWAY 5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871723",
            "telephone_number": "651-334-7322",
            "fax_number": "952-442-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 W STATE 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": "2018-11-13",
        "last_updated": "2018-11-13",
        "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": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "617666200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waconia Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waconia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.