# PROFESSIONAL PHARMACY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Professional Pharmacy, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013152198
- **Authorized official:** KEN WATERHOUSE (CFO)
- **Authorized official phone:** (719) 532-9705

## Contact information

- **Practice address:** 595 CHAPEL HILLS DR STE 104, COLORADO SPRINGS, CO 80920-1024
- **Practice address phone:** (719) 633-8278
- **Practice address fax:** (719) 228-6911
- **Mailing address:** 595 CHAPEL HILLS DR STE 104, COLORADO SPRINGS, CO 80920-1024
- **Mailing address phone:** (719) 633-8278
- **Mailing address fax:** (719) 228-6911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 754 | CO | Yes |
| 3336C0004X | Compounding Pharmacy | — | — | — |

## Other

- **Enumeration date:** 12/03/2008
- **Last updated:** 02/24/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2118132 | PK | — |
| 05 | — | 44283385 | — | CO |