Healthcare Provider Details

I. General information

NPI: 1104572668
Provider Name (Legal Business Name): PURE DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MARKET ST
WILMINGTON DE
19804-3152
US

IV. Provider business mailing address

327 W 21ST ST
CHESTER PA
19013-4917
US

V. Phone/Fax

Practice location:
  • Phone: 484-466-9379
  • Fax:
Mailing address:
  • Phone: 267-259-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BARBARA WRIGHT
Title or Position: OWNER
Credential: RN
Phone: 302-468-6611