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General NPI Number Information
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NPI Number | 1639165160
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PRESCRIPTION SERVICES LLC
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 348 FESTUS CENTRE DR
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City | FESTUS
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State | MO
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Zip | 63028-2458
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Country | US
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Telephone | 636-933-2224
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Fax | 636-933-2264
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Provider Business Mailing Address
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Address Line | 1131 N DESLOGE DR
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City | DESLOGE
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State | MO
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Zip | 63601-2936
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Country | US
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Telephone | 573-431-6677
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Fax | 573-431-3833
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DOUGLAS RADEMAKER
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Credential | RPH
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Telephone | 636-933-2224
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2004029045
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License Number State | MO
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