Healthcare Provider Details

I. General information

NPI: 1639747892
Provider Name (Legal Business Name): PROFESSIONAL PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 HIGHWAY 17 UNIT B4
MURRELLS INLET SC
29576-6434
US

IV. Provider business mailing address

PO BOX 7487
FLORENCE SC
29502-7487
US

V. Phone/Fax

Practice location:
  • Phone: 843-665-4051
  • Fax: 843-799-2493
Mailing address:
  • Phone: 843-665-4051
  • Fax: 843-799-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JONATHAN KYLE STURGEON
Title or Position: CEO
Credential:
Phone: 843-665-4051