MEDICARE: PROFESSIONAL PHARMACY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	677	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0620232	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558406884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PHARMACY SERVICES

Provider Business Mailing Address
First Line	:	3780 E 15TH ST
Second Line	:	SUITE 102
City	:	LOVELAND
State	:	CO
Zip	:	80538-8766
Country	:	US
Telephone Number	:	970-461-1975
Fax Number	:	970-461-4042

Provider Business Practice Location Address
First Line	:	7702 FIFTH ST
Second Line	:	SUITE 101
City	:	WELLINGTON
State	:	CO
Zip	:	80549-1500
Country	:	US
Telephone Number	:	970-568-7282
Fax Number	:	970-568-7529

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICKI EINHELLIG
Credential	:
Telephone Number	:	970-461-1975

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	12/15/2020

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