Provider Demographics
NPI:1861592701
Name:PROFESSIONAL PHARMACY SERVICES INC.
Entity type:Organization
Organization Name:PROFESSIONAL PHARMACY SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-222-5071
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:DERMOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71638-0250
Mailing Address - Country:US
Mailing Address - Phone:870-538-5216
Mailing Address - Fax:870-538-5219
Practice Address - Street 1:103 S FREEMAN ST
Practice Address - Street 2:
Practice Address - City:DERMOTT
Practice Address - State:AR
Practice Address - Zip Code:71638-2306
Practice Address - Country:US
Practice Address - Phone:870-538-5216
Practice Address - Fax:870-538-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty