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General NPI Number Information
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NPI Number | 1710401377
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Entity Type | Organization
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Legal Business Name | HEALTHPURE PHARMACY, LLC
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 07/26/2017
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Provider Practice Location Address
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Address Line | 3167 FULTON ST
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City | BROOKLYN
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State | NY
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Zip | 11208-1922
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Country | US
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Telephone | 718-484-8044
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Fax | 718-484-8044
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Provider Business Mailing Address
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Address Line | 93 1/2 KING ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-4343
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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 | DIRECTOR RETAIL/ECOMMERCE
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Name | MR. JEFF LOHMEIER
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Credential |
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Telephone | 505-440-2209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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