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General NPI Number Information
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NPI Number | 1639582034
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Entity Type | Organization
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Legal Business Name | PURE LIFE PHARMACY LLC
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 1502 N MCKENZIE ST STE 114
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City | FOLEY
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State | AL
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Zip | 36535-2272
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Country | US
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Telephone | 251-424-1544
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Fax | 251-424-1545
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Provider Business Mailing Address
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Address Line | 1502 N MCKENZIE ST STE 114
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City | FOLEY
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State | AL
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Zip | 36535-2272
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Country | US
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Telephone | 251-424-1544
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Fax | 251-424-1545
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY HOOVER
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Credential | PHARMD
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Telephone | 251-424-1544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 114357
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License Number State | AL
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