Provider Demographics
NPI:1902516297
Name:PURECARE PHARMACY LLC
Entity Type:Organization
Organization Name:PURECARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVRAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-484-9803
Mailing Address - Street 1:1380 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4120
Mailing Address - Country:US
Mailing Address - Phone:718-484-9803
Mailing Address - Fax:718-484-9804
Practice Address - Street 1:1380 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4120
Practice Address - Country:US
Practice Address - Phone:718-484-9803
Practice Address - Fax:718-484-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039887OtherSTATE BOARD