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General NPI Number Information
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NPI Number | 1578545687
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HOME CARE SERVICE, INC.
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 911 NORTH CHARLOTTE STREET
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City | POTTSTOWN
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State | PA
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Zip | 19464
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Country | US
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Telephone | 610-323-8750
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Fax | 610-326-0850
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Provider Business Mailing Address
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Address Line | 911 NORTH CHARLOTTE STREET
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City | POTTSTOWN
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State | PA
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Zip | 19464
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Country | US
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Telephone | 610-323-8750
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Fax | 610-326-0850
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. WALTER CHARLES STIELAU JR.
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Credential | PHARMD
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Telephone | 610-323-8750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PP414200L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | PP414200L
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License Number State | PA
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