Healthcare Provider Details

I. General information

NPI: 1770019101
Provider Name (Legal Business Name): AUDREY PURTEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WAVERLY PLZ
WAVERLY OH
45690-1222
US

IV. Provider business mailing address

220 WAVERLY PLZ
WAVERLY OH
45690-1222
US

V. Phone/Fax

Practice location:
  • Phone: 740-775-8467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03127542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: