MEDICARE: PROFESSIONAL PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy	754	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2118132	OTHER		PK

General Provider Information

NPI Number	:	1013152198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PHARMACY LLC

Provider Business Mailing Address
First Line	:	595 CHAPEL HILLS DR STE 104
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1024
Country	:	US
Telephone Number	:	719-633-8278
Fax Number	:	719-228-6911

Provider Business Practice Location Address
First Line	:	595 CHAPEL HILLS DR STE 104
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1024
Country	:	US
Telephone Number	:	719-633-8278
Fax Number	:	719-228-6911

Authorized Official
Title or Position	:	CFO
Name	:	KEN WATERHOUSE
Credential	:
Telephone Number	:	719-532-9705

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	02/24/2022

Similar Medicare Providers

1457188385 — LEAH MACK DPT
Practice Location Address:

595 CHAPEL HILLS DR STE 11
COLORADO SPRINGS, CO
80920-1024

Practice Phone: 719-285-7127
Practice Fax:

1033167655 — MR. MICHAEL W APPLEBEE PT
Practice Location Address:

595 CHAPEL HILLS DR STE 145
COLORADO SPRINGS, CO
80920-1024

Practice Phone: 719-434-7340
Practice Fax: 719-426-9857

1346273521 — PIKES PEAK ALLERGY & ASTHMA
Practice Location Address:

595 CHAPEL HILLS DR , 102
COLORADO SPRINGS, CO
80920-1024

Practice Phone: 719-578-0909
Practice Fax: 719-260-7790

1073724001 — DR. CHRISTOPHER J. KASTER DPT
Practice Location Address:

595 CHAPEL HILLS DR STE 145
COLORADO SPRINGS, CO
80920-1024

Practice Phone: 719-434-7340
Practice Fax: 719-426-9857

1659683514 — BRENDA J FELLER MPT
Practice Location Address:

595 CHAPEL HILLS DR STE 145
COLORADO SPRINGS, CO
80920-1024

Practice Phone: 719-434-7340
Practice Fax: 719-426-9857

1538590971 — DR. BRENT SALLEE DPT
Practice Location Address:

595 CHAPEL HILLS DR STE 145
COLORADO SPRINGS, CO
80920-1024

Practice Phone: 719-434-7340
Practice Fax: 719-426-9857

Directions to “PROFESSIONAL PHARMACY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.