1568907913 NPI number — PURE PHARMACY

Table of content: AMIR MAHFOOZ MULLICK MD (NPI 1780487264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568907913 NPI number — PURE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURE PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568907913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 674172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-4172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-572-1011
Provider Business Mailing Address Fax Number:
512-572-1021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1927 LOHMANS CROSSING RD STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWAY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-572-1011
Provider Business Practice Location Address Fax Number:
512-572-1021
Provider Enumeration Date:
12/21/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHEUNG
Authorized Official First Name:
MOKY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
512-572-1011

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 31137 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2165798 . This is a "PK" identifier . This identifiers is of the category "OTHER".