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General NPI Number Information
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NPI Number | 1104571363
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Entity Type | Organization
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Legal Business Name | PUREMEDS LLC
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 659 BIG BEND RD
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City | MANCHESTER
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State | MO
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Zip | 63021-7723
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Country | US
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Telephone | 636-438-5095
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Fax |
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Provider Business Mailing Address
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Address Line | 659 BIG BEND RD
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City | MANCHESTER
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State | MO
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Zip | 63021-7723
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Country | US
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Telephone | 636-438-5095
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER/OWNER
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Name | HAREESH KUMAR REDDY PALLI
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Credential | RPH
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Telephone | 314-359-2389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care 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 | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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