Provider Demographics
NPI:1942975420
Name:PURE ELEGANCE RX LLC
Entity Type:Organization
Organization Name:PURE ELEGANCE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROSTHESIS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CAPRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-601-0622
Mailing Address - Street 1:27020 PAC HWY S
Mailing Address - Street 2:STE A #15
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032
Mailing Address - Country:US
Mailing Address - Phone:206-742-2735
Mailing Address - Fax:201-455-6135
Practice Address - Street 1:27020 PAC HWY S
Practice Address - Street 2:STE A #15
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032
Practice Address - Country:US
Practice Address - Phone:206-742-2735
Practice Address - Fax:201-455-6135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier