Provider Demographics
NPI:1043878598
Name:LEGRANDERX PHARMACY LLC
Entity Type:Organization
Organization Name:LEGRANDERX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:HOIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:509-953-6863
Mailing Address - Street 1:343 E 4TH N STE 126
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-6004
Mailing Address - Country:US
Mailing Address - Phone:855-534-7263
Mailing Address - Fax:208-421-9792
Practice Address - Street 1:343 E 4TH N STE 126
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-6004
Practice Address - Country:US
Practice Address - Phone:855-534-7263
Practice Address - Fax:208-421-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy