Provider Demographics
NPI:1720680390
Name:PURA, ANNA NICOLE RAMIREZ (RPH)
Entity Type:Individual
Prefix:
First Name:ANNA NICOLE
Middle Name:RAMIREZ
Last Name:PURA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1914
Mailing Address - Country:US
Mailing Address - Phone:301-530-3271
Mailing Address - Fax:844-411-6244
Practice Address - Street 1:10400 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1914
Practice Address - Country:US
Practice Address - Phone:301-530-3271
Practice Address - Fax:844-411-6244
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist