Provider Demographics
NPI:1750321402
Name:PROFESSIONAL PHARMACY SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY SERVICES
Other - Org Name:GOOD DAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:EINHELLIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:970-461-1975
Mailing Address - Street 1:3780 E 15TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8766
Mailing Address - Country:US
Mailing Address - Phone:970-461-1975
Mailing Address - Fax:970-461-4042
Practice Address - Street 1:4775 LARIMER PARKWAY
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9021
Practice Address - Country:US
Practice Address - Phone:970-461-9101
Practice Address - Fax:970-461-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5133336I0012X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0618465OtherOTHER ID NUMBER
0618465OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CO62100343Medicaid
0618465OtherOTHER ID NUMBER-COMMERCIAL NUMBER