Provider Demographics
NPI:1669834990
Name:LEGANZA, NANNETTE (RPH)
Entity type:Individual
Prefix:MRS
First Name:NANNETTE
Middle Name:
Last Name:LEGANZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-2426
Mailing Address - Country:US
Mailing Address - Phone:570-968-1320
Mailing Address - Fax:
Practice Address - Street 1:300 HOLLYWOOD BVD
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17963
Practice Address - Country:US
Practice Address - Phone:570-968-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038371L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy