Organization
PURE COMPOUNDING
Active
Other names
PURE COMPOUNDING
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA LEE (OWNER)
(843) 651-7979
Entity
Organization
Contact information
Practice address
3072 DICK POND RD, STE 2, MYRTLE BEACH, SC 29588-6954
(843) 293-7979
(843) 293-6499
Mailing address
3072 DICK POND RD, STE 2, MYRTLE BEACH, SC 29588-6954
(843) 293-7979
(843) 293-6499
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
9639
SC
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093410
PK
—
Enumeration date
09/25/2007
Last updated
04/19/2016
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