Provider Demographics
NPI:1831125210
Name:PROFESSIONAL PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY SERVICES, INC.
Other - Org Name:PPS PERSONAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:REGIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-392-3300
Mailing Address - Street 1:100 E RIVERCENTER BLVD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1555
Mailing Address - Country:US
Mailing Address - Phone:859-392-3300
Mailing Address - Fax:
Practice Address - Street 1:10947 MCCORMICK RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1401
Practice Address - Country:US
Practice Address - Phone:410-229-0167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL PHARMACY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-25
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW03293336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD057980700Medicaid
2118342OtherNCPDP