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General NPI Number Information
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NPI Number | 1790380830
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Entity Type | Organization
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Legal Business Name | PURAMINT LLC
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 9305 LEESVILLE RD
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City | RALEIGH
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State | NC
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Zip | 27613-2761
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Country | US
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Telephone | 903-933-9459
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Fax |
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Provider Business Mailing Address
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Address Line | 13200 STRICKLAND RD STE 114-346
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City | RALEIGH
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State | NC
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Zip | 27613-5212
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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 | PHARMACIST IN CHARGE
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Name | JOHN THORNSBERRY
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Credential | PHARMD
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Telephone | 984-302-3001
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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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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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