Provider Demographics
NPI:1376300368
Name:LEGENDS PHARMACY III SERVICES LLC
Entity Type:Organization
Organization Name:LEGENDS PHARMACY III SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSYN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:210-842-5274
Mailing Address - Street 1:6601 BLANCO RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6105
Mailing Address - Country:US
Mailing Address - Phone:210-510-2692
Mailing Address - Fax:210-736-4438
Practice Address - Street 1:500 LOUISIANA BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2051
Practice Address - Country:US
Practice Address - Phone:505-262-5728
Practice Address - Fax:844-646-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy