Healthcare Provider Details

I. General information

NPI: 1447904131
Provider Name (Legal Business Name): PURE HYDRATION FLOW AND ENHANCEMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LONG LN STE 3
UPPER DARBY PA
19082-3439
US

IV. Provider business mailing address

PO BOX 60
UPPER DARBY PA
19082-0060
US

V. Phone/Fax

Practice location:
  • Phone: 484-661-2257
  • Fax: 610-734-0272
Mailing address:
  • Phone: 484-661-2257
  • Fax: 610-734-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: KATINA CARTER GEIGER
Title or Position: MANAGER
Credential:
Phone: 484-661-2257