Provider Demographics
NPI:1215238928
Name:PURE PHARMACY LLC
Entity type:Organization
Organization Name:PURE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:MISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-903-0059
Mailing Address - Street 1:959 WEST AVE
Mailing Address - Street 2:SUITE #16
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-5201
Mailing Address - Country:US
Mailing Address - Phone:305-532-1300
Mailing Address - Fax:305-532-1500
Practice Address - Street 1:959 WEST AVE STE 16
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-5214
Practice Address - Country:US
Practice Address - Phone:305-532-1300
Practice Address - Fax:305-532-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH250333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128181OtherPK