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1104571363 NPI number — PUREMEDS LLC

NPI Number: 1104571363
Health Care Provider/Practitioner: PUREMEDS LLC

Information about “1104571363” NPI (PUREMEDS LLC) exists in 1104571363 in HTML format HTML  |  1104571363 in plain Text format TXT  |  1104571363 in PDF (Portable Document Format) PDF  |  1104571363 in an XML format XML  formats.

NPI Number : 1104571363 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104571363",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PUREMEDS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "659 BIG BEND RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANCHESTER",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63021-7723",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "636-438-5095",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "659 BIG BEND RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANCHESTER",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63021-7723",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "636-438-5095",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/16/2022",
    "LastUpdateDate": "03/23/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PALLI",
    "AuthorizedOfficialFirstName": "HAREESH KUMAR REDDY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PHARMACY MANAGER/OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RPH",
    "AuthorizedOfficialTelephoneNumber": "314-359-2389",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336L0003X",
          "TaxonomyName": "Long Term Care Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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