# PHARMACY & PHARMACEUTICAL SERVICES PROVIDER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PPSP LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619378890
- **Authorized official:** MR. FELIX F ETEBOM BS BSPHARM (PRESIDENT,CEO & OWNER)
- **Authorized official phone:** (301) 352-2514

## Contact information

- **Practice address:** 13202 STEEPLECHASE DR, BOWIE, MD 20715-4542
- **Practice address phone:** (301) 352-2514
- **Practice address fax:** (301) 805-0664
- **Mailing address:** 13202 STEEPLECHASE DR, BOWIE, MD 20715-4542
- **Mailing address phone:** (301) 352-2514
- **Mailing address fax:** (301) 805-0664

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171W00000X | Contractor | 13780 | MD | — |
| 174400000X | Specialist | 13780 | MD | — |
| 1744R1102X | Research Study Specialist | 13780 | MD | — |
| 174H00000X | Health Educator | 13780 | MD | — |
| 183500000X | Pharmacist | 13780 | MD | — |
| 1835G0303X | Geriatric Pharmacist | 13780 | MD | — |
| 1835N1003X | Nutrition Support Pharmacist | 13780 | MD | — |
| 1835P0018X | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 13780 | MD | Yes |
| 1835P1200X | Pharmacotherapy Pharmacist | 13780 | MD | — |

## Other

- **Enumeration date:** 09/08/2014
- **Last updated:** 12/08/2022