Organization
PROFESSIONAL SPECIALTY PHARMACY, LLC
Active
Other names
Professional Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN BOWMAN (MEMBER/MANAGER)
(919) 603-3824
Entity
Organization
Contact information
Practice address
142 ROXBORO RD, OXFORD, NC 27565-2642
(919) 603-3824
(919) 603-3847
Mailing address
142 ROXBORO RD, OXFORD, NC 27565-2642
(919) 603-3824
(919) 603-3847
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
11338
NC
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3460401
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/13/2012
Last updated
09/13/2012
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