Healthcare Provider Details

I. General information

NPI: 1912012220
Provider Name (Legal Business Name): PROFESSIONAL PHARMACY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 FAIRMOUNT AVE
TOWSON MD
21286-5466
US

IV. Provider business mailing address

201 E 4TH ST 900 OMNICARE CENTER
CINCINNATI OH
45202-4248
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-9895
  • Fax: 410-583-1654
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO1827
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier697200400
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer
# 2
Identifier2119661
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP

VIII. Authorized Official

Name: ANGELA JAMES
Title or Position: REGULATORY LICENSING MANGAGER
Credential:
Phone: 513-719-2600