Provider Demographics
NPI:1902309446
Name:POFESSIONAL SERVICE PHARMACY, LLC
Entity Type:Organization
Organization Name:POFESSIONAL SERVICE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTLOW
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:901-921-5445
Mailing Address - Street 1:7313 DOWNMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-1213
Mailing Address - Country:US
Mailing Address - Phone:504-309-5741
Mailing Address - Fax:504-309-5587
Practice Address - Street 1:7313 DOWNMAN RD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1213
Practice Address - Country:US
Practice Address - Phone:504-309-5741
Practice Address - Fax:504-309-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007594.IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy