MEDICARE: PURDY PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1205580933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURDY PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX B
Second Line	:
City	:	ILWACO
State	:	WA
Zip	:	98624-0167
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14218 92ND AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-8710
Country	:	US
Telephone Number	:	253-857-7797
Fax Number	:	253-857-7679

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY SHANE HARRELL
Credential	:	PHARMD
Telephone Number	:	360-859-8659

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	12/29/2025

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Directions to “PURDY PHARMACY INC ” Practice Location

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