Provider Demographics
NPI:1407576606
Name:PROFESSIONAL ARTS PHARMACY, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL ARTS PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DUNBAR
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:731-614-4259
Mailing Address - Street 1:148 WEST CHURCH ST. SUITE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2069
Mailing Address - Country:US
Mailing Address - Phone:731-968-5474
Mailing Address - Fax:731-798-5079
Practice Address - Street 1:148 WEST CHURCH ST. SUITE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2069
Practice Address - Country:US
Practice Address - Phone:731-968-5474
Practice Address - Fax:731-798-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4430144OtherNCPDP