Purgatory Pharmaceutical Services Llc

NPI Registration Record

Provider / Organization	NPI	Date Certified
PURGATORY PHARMACEUTICAL SERVICES LLC	1801582341	2023-04-17

The organization Purgatory Pharmaceutical Services Llc is registered with the National Plan and Provider Enumeration System (NPPES) and has the assigned NPI of 1801582341. Registration indicates Purgatory Pharmaceutical Services Llc is a provider of services with a specialization in Suppliers, Pharmacy (Pharmacy, ) (Pharmacy/DME, ) (Pharmacy, Suppliers) Access to Pharmacies (Suppliers, Pharmacy) (Suppliers, Pharmacy) (Pharmacy: Community/Retail Pharmacy, ) (Pharmacy/DME, ) (Pharmacy Community/Retail Pharmacy, Suppliers) (Pharmacy, )

Other Names:

• Jack's Market Pharmacy

Entity Type	Organization
Provider Organization	PURGATORY PHARMACEUTICAL SERVICES LLC
Other Provider Organization	JACK'S MARKET PHARMACY
Practice Office Address	222 SOLAR AVE MONTE VISTA, CO US
Practice Office Telephone	7198529894
Practice Office Fax	7198529897
Mailing Address	PO BOX 546 CRESTONE, CO 811310546 US
Business Telephone	7198529894
Business Fax	7198529897
Authorized Official	IAN MCMULLEN, MANAGING MEMBER 7198529894

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