Provider Demographics
NPI:1073534160
Name:PROFESSIONAL PHARMACY SOLUTIONS
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY SOLUTIONS
Other - Org Name:MEDICAL ARTS CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-657-2565
Mailing Address - Street 1:3124 WILMINGTON RD
Mailing Address - Street 2:SUITE 204 MAYZON BLDG
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1100
Mailing Address - Country:US
Mailing Address - Phone:724-657-2565
Mailing Address - Fax:724-652-7148
Practice Address - Street 1:3124 WILMINGTON RD
Practice Address - Street 2:SUITE 204 MAYZON BLDG
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1100
Practice Address - Country:US
Practice Address - Phone:724-657-2565
Practice Address - Fax:724-652-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415596L333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007302610001Medicaid
PA4087840001Medicare NSC