Healthcare Provider Details

I. General information

NPI: 1326651555
Provider Name (Legal Business Name): PURFORMANCE WELLNESS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 HERITAGE DR STE 101
JUPITER FL
33458-5286
US

IV. Provider business mailing address

555 HERITAGE DR STE 101
JUPITER FL
33458-5286
US

V. Phone/Fax

Practice location:
  • Phone: 561-467-5333
  • Fax: 561-467-4899
Mailing address:
  • Phone: 561-467-5333
  • Fax: 561-467-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SCOTT SHARP
Title or Position: MANAGER
Credential:
Phone: 561-467-5333