Provider Demographics
NPI:1750749297
Name:SIMPLY PURE RX INC
Entity type:Organization
Organization Name:SIMPLY PURE RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSLEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-227-0505
Mailing Address - Street 1:1607 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3717
Mailing Address - Country:US
Mailing Address - Phone:847-227-8020
Mailing Address - Fax:847-868-8426
Practice Address - Street 1:1607 BENSON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3717
Practice Address - Country:US
Practice Address - Phone:847-227-8020
Practice Address - Fax:847-868-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336S0011X
IL0540193233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157929OtherPK