Provider Demographics
NPI:1770291940
Name:PROFESSIONAL PRESCRIPTION SERVICES LLC
Entity type:Organization
Organization Name:PROFESSIONAL PRESCRIPTION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RADEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-933-2224
Mailing Address - Street 1:348 FESTUS CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2458
Mailing Address - Country:US
Mailing Address - Phone:636-933-2224
Mailing Address - Fax:636-933-2264
Practice Address - Street 1:348 FESTUS CENTRE DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2458
Practice Address - Country:US
Practice Address - Phone:636-933-2224
Practice Address - Fax:636-933-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy