Healthcare Provider Details

I. General information

NPI: 1003814617
Provider Name (Legal Business Name): PROFESSIONAL SPECIALIZED PHARMACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4627 ROUTE 51 SUITE 602
BELLE VERNON PA
15012-4010
US

IV. Provider business mailing address

4627 ROUTE 51 SUITE 602
BELLE VERNON PA
15012-4010
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-6000
  • Fax: 724-379-8548
Mailing address:
  • Phone: 724-379-6000
  • Fax: 724-379-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP415631L
License Number StatePA

VIII. Authorized Official

Name: MR. SHAWN R. NAIRN
Title or Position: DIRECTOR OF RETAIL OPERATIONS
Credential: RPH
Phone: 412-389-1250