Provider Demographics
NPI:1639747892
Name:PROFESSIONAL PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:STURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-665-4051
Mailing Address - Street 1:PO BOX 7487
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-7487
Mailing Address - Country:US
Mailing Address - Phone:843-665-4051
Mailing Address - Fax:843-799-2493
Practice Address - Street 1:4410 HIGHWAY 17 UNIT B4
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6434
Practice Address - Country:US
Practice Address - Phone:843-665-4051
Practice Address - Fax:843-799-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies