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NPI Code Detail

MEDICARE: PURE PHARMACY LLC

MEDICARE: PURE PHARMACY LLC
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
13336C0003XCommunity/Retail PharmacyPH25033FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12128181OTHERPK

General Provider Information

NPI Number : 1215238928
Entity Type Code : Organization
Provider Name (Legal Business Name) : PURE PHARMACY LLC
Provider Business Mailing Address
First Line : 959 WEST AVE
Second Line : SUITE #16
City : MIAMI BEACH
State : FL
Zip : 33139-5201
Country : US
Telephone Number : 305-532-1300
Fax Number : 305-532-1500
Provider Business Practice Location Address
First Line : 959 WEST AVE STE 16
Second Line :
City : MIAMI BEACH
State : FL
Zip : 33139-5214
Country : US
Telephone Number : 305-532-1300
Fax Number : 305-532-1500
Authorized Official
Title or Position : OWNER,PIC,AO
Name : MISHAL ALSABBAGH
Credential : RPH
Telephone Number : 305-903-0059
Provider Enumeration Date : 11/11/2010
Last Update Date : 10/02/2015

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Directions to “PURE PHARMACY LLC ” Practice Location

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