Provider Demographics
NPI:1093580300
Name:LEGACY PHARMACY CF, LLC
Entity Type:Organization
Organization Name:LEGACY PHARMACY CF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-730-7989
Mailing Address - Street 1:10967 LAKE UNDERHILL RD STE 118
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4454
Mailing Address - Country:US
Mailing Address - Phone:407-730-7989
Mailing Address - Fax:
Practice Address - Street 1:1060 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4104
Practice Address - Country:US
Practice Address - Phone:407-730-7989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy