Provider Demographics
NPI:1336386630
Name:PROFESSIONAL PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELVANG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-970-6988
Mailing Address - Street 1:11650 RIVERSIDE DR
Mailing Address - Street 2:#6
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1093
Mailing Address - Country:US
Mailing Address - Phone:818-970-6988
Mailing Address - Fax:
Practice Address - Street 1:11650 RIVERSIDE DR
Practice Address - Street 2:#6
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1093
Practice Address - Country:US
Practice Address - Phone:818-970-6988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48584251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion