Healthcare Provider Details

I. General information

NPI: 1700827441
Provider Name (Legal Business Name): PROFESSIONAL PHARMACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4239 CENTERPLACE DR UNIT 1D
GREELEY CO
80634-3773
US

IV. Provider business mailing address

3780 E 15TH ST SUITE 102
LOVELAND CO
80538-8766
US

V. Phone/Fax

Practice location:
  • Phone: 970-576-3178
  • Fax: 970-392-4712
Mailing address:
  • Phone: 970-461-1975
  • Fax: 970-461-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number560000004
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: VICKI EINHELLIG
Title or Position: PRESIDENT
Credential: RPH
Phone: 970-461-1975