Provider Demographics
NPI:1174161244
Name:LEGACY COMMUNITY PHARMACY SERVICES
Entity type:Organization
Organization Name:LEGACY COMMUNITY PHARMACY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GURWITCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:832-548-5022
Mailing Address - Street 1:1415 CALIFORNIA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2602
Mailing Address - Country:US
Mailing Address - Phone:832-548-5022
Mailing Address - Fax:
Practice Address - Street 1:6441 HIGH STAR DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5005
Practice Address - Country:US
Practice Address - Phone:713-814-3499
Practice Address - Fax:832-548-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy