Provider Demographics
NPI:1316004633
Name:PREFERRED CARE PHARMACEUTICAL SERVICES INC
Entity Type:Organization
Organization Name:PREFERRED CARE PHARMACEUTICAL SERVICES INC
Other - Org Name:PREFERRED CARE PHARMACEUTICAL SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-769-6522
Mailing Address - Street 1:4794 A HWY 162
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29449
Mailing Address - Country:US
Mailing Address - Phone:843-769-6522
Mailing Address - Fax:843-769-5728
Practice Address - Street 1:4794 A HWY 162
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449
Practice Address - Country:US
Practice Address - Phone:843-769-6522
Practice Address - Fax:843-769-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500059023336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC735696Medicaid
4219780OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1162570001Medicare NSC