LEGACY DRUGSTORE LLC NPI 1396291837

NPI Information

  • NPI: 1396291837
  • Provider Name: LEGACY DRUGSTORE LLC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • Doing Business As: LEGACY DRUGSTORE
  • Address: 13000 VETERANS MEMORIAL PKWY
    SUITE A
    WRIGHT CITY, MO
    ZIP 63390
  • Phone: (636) 791-1274

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NPI Details

LEGACY DRUGSTORE LLC is a community/retail pharmacy pharmacy in Wright City, MO. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. LEGACY DRUGSTORE LLC NPI is 1396291837. The provider is registered as an organization entity type.
The provider Is Doing Business As Legacy Drugstore.

The provider's business location address is:

13000 VETERANS MEMORIAL PKWY
SUITE A
WRIGHT CITY, MO
ZIP 63390-041
Phone: (636) 791-1274
Fax: (636) 791-1326

The provider's authorized official is Mitchell Graumenz .
The authorized official title is Pic and has the following contact phone number (618) 267-0574.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)
  • Fee covid-19 vac 13 res (HCPCS:0124A)
  • Adm sarscv2 30mcg trs-sucr b (HCPCS:0054A)
  • Adm sarscov2 50mcg/0.25mlbst (HCPCS:0064A)
  • Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free (HCPCS:90674)

The enumeration date for this NPI number is 8/25/2016 and was last updated on 12/21/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
23336C0003XPharmacyCommunity/Retail Pharmacy2016040867MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12163841OTHERPK
2600037942MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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