Healthcare Provider Details

I. General information

NPI: 1770127946
Provider Name (Legal Business Name): PROFESSIONAL PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N CHARLOTTE ST
POTTSTOWN PA
19464-3958
US

IV. Provider business mailing address

911 N CHARLOTTE ST
POTTSTOWN PA
19464-3958
US

V. Phone/Fax

Practice location:
  • Phone: 610-632-8838
  • Fax: 610-632-8858
Mailing address:
  • Phone: 610-632-8838
  • Fax: 610-632-8858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierPP482930
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE PHARMACY LICENSE

VIII. Authorized Official

Name: DAVID STONE
Title or Position: OWNER
Credential: PHARM.D.
Phone: 610-632-8838