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General NPI Number Information
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NPI Number | 1033917810
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Entity Type | Organization
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Legal Business Name | PURE PATH COMPOUNDING PHARMACY LLC
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 2141 W AIRPORT WAY STE 700
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City | BOISE
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State | ID
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Zip | 83705-5168
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Country | US
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Telephone | 208-985-3575
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Fax |
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Provider Business Mailing Address
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Address Line | 2141 W AIRPORT WAY STE 700
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City | BOISE
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State | ID
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Zip | 83705-5168
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | KEVIN CRUMLEY
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Credential |
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Telephone | 208-985-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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