Provider Demographics
NPI:1992361729
Name:PURECARE PHARMACY LLC
Entity type:Organization
Organization Name:PURECARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:CHUKWUEMEKA
Authorized Official - Last Name:ABALIHI
Authorized Official - Suffix:
Authorized Official - Credentials:(PHARMD)
Authorized Official - Phone:813-364-8100
Mailing Address - Street 1:6834 GALL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2506
Mailing Address - Country:US
Mailing Address - Phone:813-364-8100
Mailing Address - Fax:813-322-8326
Practice Address - Street 1:6834 GALL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2506
Practice Address - Country:US
Practice Address - Phone:813-364-8100
Practice Address - Fax:813-322-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104514700Medicaid
FL025096400Medicaid