Organization
PURGATORY PHARMACEUTICAL SERVICES LLC
Active
Organization
PURGATORY PHARMACEUTICAL SERVICES LLC
Active
Other names
Jack's Market Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
IAN MCMULLEN PHARMD (MANAGING MEMBER, PHARMACIST)
(719) 852-9894
Entity
Organization
Contact information
Practice address
222 SOLAR AVE, MONTE VISTA, CO 81144-1066
(719) 852-9894
(719) 852-9897
Mailing address
PO BOX 546, CRESTONE, CO 81131-0546
(719) 852-9894
(719) 852-9897
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
04/17/2023
Last updated
10/17/2023
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