Healthcare Provider Details

I. General information

NPI: 1205580933
Provider Name (Legal Business Name): PURDY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14218 92ND AVE NW
GIG HARBOR WA
98329-8710
US

IV. Provider business mailing address

PO BOX B
ILWACO WA
98624-0167
US

V. Phone/Fax

Practice location:
  • Phone: 253-857-7797
  • Fax: 253-857-7679
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY SHANE HARRELL
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 253-857-7797