Organization
PURE PATH COMPOUNDING PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN CRUMLEY (OPERATIONS MANAGER)
(208) 985-3575
Entity
Organization
Contact information
Practice address
2141 W AIRPORT WAY STE 700, BOISE, ID 83705-5168
(208) 985-3575
Mailing address
2141 W AIRPORT WAY STE 700, BOISE, ID 83705-5168
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Enumeration date
03/06/2025
Last updated
03/24/2025
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