Provider Demographics
NPI:1225708225
Name:LEGACY APOTHECARY LP
Entity Type:Organization
Organization Name:LEGACY APOTHECARY LP
Other - Org Name:RENUE RX #12
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:CHHADUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-422-2598
Mailing Address - Street 1:PO BOX 2735
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0051
Mailing Address - Country:US
Mailing Address - Phone:214-422-2598
Mailing Address - Fax:
Practice Address - Street 1:150 N COPPELL RD STE PHARMACY
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2293
Practice Address - Country:US
Practice Address - Phone:972-371-0067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care