Provider Demographics
NPI:1104868405
Name:PROFESSIONAL PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY SERVICES, INC.
Other - Org Name:PUGET SOUND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGULATORY LICENSING MANGAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-719-2600
Mailing Address - Street 1:201 E 4TH ST
Mailing Address - Street 2:900 OMNICARE CENTER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-4248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1112 6TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4040
Practice Address - Country:US
Practice Address - Phone:253-272-1107
Practice Address - Fax:253-272-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
WACF000591093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4913768OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WA6030738Medicaid
1109290032Medicare NSC