Provider Demographics
NPI:1811388622
Name:PROGRESSIVE HEALTH SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTH SERVICES
Other - Org Name:UNITED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-783-1828
Mailing Address - Street 1:200 BROADKILL RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1010
Mailing Address - Country:US
Mailing Address - Phone:302-664-1220
Mailing Address - Fax:302-664-1084
Practice Address - Street 1:200 BROADKILL RD STE 2
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1010
Practice Address - Country:US
Practice Address - Phone:302-664-1220
Practice Address - Fax:302-664-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DEA3-00009823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150491OtherPK