Provider Demographics
NPI:1376825547
Name:LEGACY CONSULTANT PHARMACY
Entity Type:Organization
Organization Name:LEGACY CONSULTANT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-441-8812
Mailing Address - Street 1:7505 RIGHT FLANK RD STE 710
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3865
Mailing Address - Country:US
Mailing Address - Phone:804-441-8812
Mailing Address - Fax:804-559-8195
Practice Address - Street 1:7505 RIGHT FLANK RD STE 710
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3865
Practice Address - Country:US
Practice Address - Phone:804-441-8812
Practice Address - Fax:804-559-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010044173336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy