Provider Demographics
NPI:1104424274
Name:LEGGE, RONALD GREGORY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:GREGORY
Last Name:LEGGE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9853 RUNNING BROOK LN
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9625
Mailing Address - Country:US
Mailing Address - Phone:303-530-4113
Mailing Address - Fax:
Practice Address - Street 1:455 E WONDER VIEW AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-8927
Practice Address - Country:US
Practice Address - Phone:303-530-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107761835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03001708Medicaid