Organization
PROFESSIONAL PHARMACY, LLC
Active
Other names
Professional Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KEN WATERHOUSE (CFO)
(719) 532-9705
Entity
Organization
Contact information
Practice address
595 CHAPEL HILLS DR STE 104, COLORADO SPRINGS, CO 80920-1024
(719) 633-8278
(719) 228-6911
Mailing address
595 CHAPEL HILLS DR STE 104, COLORADO SPRINGS, CO 80920-1024
(719) 633-8278
(719) 228-6911
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44283385
—
CO
Enumeration date
04/30/2019
Last updated
04/30/2019
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