Provider Demographics
NPI:1770628307
Name:PROFESSIONAL PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY SERVICES, INC.
Other - Org Name:GOOD DAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, COO
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKILEE
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:EINHELLIG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:970-461-1975
Mailing Address - Street 1:3780 E 15TH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-461-1975
Mailing Address - Fax:970-461-4042
Practice Address - Street 1:315 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:CO
Practice Address - Zip Code:80759
Practice Address - Country:US
Practice Address - Phone:970-848-5427
Practice Address - Fax:970-848-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CO13200000033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03808029Medicaid
2001214OtherPK
0606321OtherNCPDP PROVIDER IDENTIFICATION NUMBER