Provider Demographics
NPI:1548413115
Name:LEGACY SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:LEGACY SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-423-2299
Mailing Address - Street 1:8080 SPANISH FORT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-5423
Mailing Address - Country:US
Mailing Address - Phone:251-423-2299
Mailing Address - Fax:251-621-8263
Practice Address - Street 1:8080 SPANISH FORT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-5423
Practice Address - Country:US
Practice Address - Phone:251-423-2299
Practice Address - Fax:251-621-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL113046333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy