Provider Demographics
NPI:1689920498
Name:PEGASUS PHARMACY LLC
Entity Type:Organization
Organization Name:PEGASUS PHARMACY LLC
Other - Org Name:LEGACY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:602-561-6432
Mailing Address - Street 1:2050 SPRINGDALE RD.
Mailing Address - Street 2:UNIT 500
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:856-528-3900
Mailing Address - Fax:856-424-2096
Practice Address - Street 1:2050 SPRINGDALE RD
Practice Address - Street 2:UNIT 500
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2045
Practice Address - Country:US
Practice Address - Phone:856-528-3900
Practice Address - Fax:856-424-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007230003336C0004X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136982OtherPK