Purgatory Pharmaceutical Services LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PURGATORY PHARMACEUTICAL SERVICES LLC

Doing business as

Jack's Market Pharmacy

Practice address

222 Solar Ave
Monte Vista, CO 81144-1066

Phone

(719) 852-9894

Fax

(719) 852-9897

NPI assigned

Apr 17, 2023

Last updated

Oct 17, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ian McMullen, PHARMDNPI 1952786105

Title

Managing Member, Pharmacist

Phone

(719) 852-9894

Specialties & licenses 2

Addresses

Other names 1

• Jack's Market Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CO2 enrollments

Enrollment records 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ian Charles McMullen, PHARM.D., RPH.

  • Pharmacist
  • Monte Vista, CO
  • NPI 1952786105
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1801582341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 546",
            "city": "CRESTONE",
            "state": "CO",
            "postal_code": "811310546",
            "telephone_number": "719-852-9894",
            "fax_number": "719-852-9897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 SOLAR AVE",
            "city": "MONTE VISTA",
            "state": "CO",
            "postal_code": "811441066",
            "telephone_number": "719-852-9894",
            "fax_number": "719-852-9897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURGATORY PHARMACEUTICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "MCMULLEN",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "MANAGING MEMBER, PHARMACIST",
        "authorized_official_telephone_number": "719-852-9894",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jack's Market Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jack's Market Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Monte Vista, CO
• Providers in Monte Vista, CO by specialty
• Community/Retail Pharmacy in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.