Provider Demographics
NPI:1972742195
Name:LEGENDS PHARMACY II, LP
Entity Type:Organization
Organization Name:LEGENDS PHARMACY II, LP
Other - Org Name:LEGENDS PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PHARMACY OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIPAOLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARMD
Authorized Official - Phone:210-510-2692
Mailing Address - Street 1:6601 BLANCO ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216
Mailing Address - Country:US
Mailing Address - Phone:210-510-2692
Mailing Address - Fax:210-736-4438
Practice Address - Street 1:1602 AVENUE D STE 500
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3646
Practice Address - Country:US
Practice Address - Phone:281-496-0640
Practice Address - Fax:844-646-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX264363336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350222Medicaid