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General NPI Number Information
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NPI Number | 1700805934
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHARMACEUTICAL SERVICES, INC.
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 1883 EUCLID AVE
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City | BRISTOL
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State | VA
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Zip | 24201-3605
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Country | US
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Telephone | 276-466-3600
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Fax | 276-466-3578
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Provider Business Mailing Address
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Address Line | 1883 EUCLID AVE
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City | BRISTOL
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State | VA
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Zip | 24201-3605
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Country | US
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Telephone | 276-466-3600
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Fax | 276-466-3578
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | DR. JOHN MILLARD VANDEVENTER
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Credential | PHARM. D.
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Telephone | 276-466-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201001918
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License Number State | VA
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