MEDICARE: PROFESSIONAL PHARMACY SERVICES, INC

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	50-006977	SC
2	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598758955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PHARMACY SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 7487
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502-7487
Country	:	US
Telephone Number	:	843-665-4051
Fax Number	:	843-799-2493

Provider Business Practice Location Address
First Line	:	773 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3029
Country	:	US
Telephone Number	:	843-665-4051
Fax Number	:	843-799-2493

Authorized Official
Title or Position	:	CEO
Name	:	MR. JONATHAN KYLE STURGEON
Credential	:
Telephone Number	:	843-665-4051

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	06/15/2021

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Directions to “PROFESSIONAL PHARMACY SERVICES, INC ” Practice Location

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