Provider Demographics
NPI:1710401377
Name:HEALTHPURE PHARMACY, LLC
Entity Type:Organization
Organization Name:HEALTHPURE PHARMACY, LLC
Other - Org Name:HEALTHPURE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR RETAIL/ECOMMERCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-440-2209
Mailing Address - Street 1:93 1/2 KING ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3167 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1922
Practice Address - Country:US
Practice Address - Phone:718-484-8044
Practice Address - Fax:718-484-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy