Organization
PROFESSIONAL PHARMACY SERVICES, INC
Active
Other names
Coastal Respiratory and Brace Store
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN KYLE STURGEON (CEO)
(843) 665-4051
Entity
Organization
Contact information
Practice address
773 MAIN ST, NORTH MYRTLE BEACH, SC 29582-3029
(843) 665-4051
(843) 799-2493
Mailing address
PO BOX 7487, FLORENCE, SC 29502-7487
(843) 665-4051
(843) 799-2493
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
50-006977
SC
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
769771
—
SC
05
—
DME-197
—
SC
Enumeration date
08/31/2005
Last updated
06/15/2021
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