MEDICARE: PROFESSIONAL PHARMACY SERVICES

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	3336I0012X	Institutional Pharmacy	513	CO
2	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0618465	OTHER	OTHER ID NUMBER
2	0618465	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750321402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PHARMACY SERVICES

Provider Business Mailing Address
First Line	:	3780 E 15TH ST
Second Line	:	SUITE 102
City	:	LOVELAND
State	:	CO
Zip	:	80538-8766
Country	:	US
Telephone Number	:	970-461-1975
Fax Number	:	970-461-4042

Provider Business Practice Location Address
First Line	:	4775 LARIMER PARKWAY
Second Line	:
City	:	JOHNSTOWN
State	:	CO
Zip	:	80534-9021
Country	:	US
Telephone Number	:	970-461-9101
Fax Number	:	970-461-9089

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICKI EINHELLIG
Credential	:	PHARMD
Telephone Number	:	970-461-1975

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/19/2015

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Directions to “PROFESSIONAL PHARMACY SERVICES ” Practice Location

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