Organization
PROFESSIONAL PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAN SLUSHER RPH (PHARMACIST OWNER)
(606) 679-1169
Entity
Organization
Contact information
Practice address
342 BOGLE ST, SUITE 3, SOMERSET, KY 42503-2851
(606) 679-7979
(606) 678-0370
Mailing address
342 BOGLE ST, SUITE 3, SOMERSET, KY 42503-2851
(606) 679-1169
(606) 679-1049
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
6797
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000245485
ANTHEM PROVIDER NUMBER
KY
05
—
54004221
—
KY
05
—
90005240
—
KY
Enumeration date
10/05/2005
Last updated
05/12/2008
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