Organization
PROFESSIONAL PHARMACY SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHALIL L CROUSE (MANAGER)
(870) 265-2220
Entity
Organization
Contact information
Practice address
1907 N MEDICAL PARK DR, SUITE 103, GREENVILLE, MS 38703-7240
(662) 378-3850
(662) 332-0195
Mailing address
PO BOX 552, LAKE VILLAGE, AR 71653-0552
(662) 378-8860
(662) 378-8618
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
AR-20331
AR
332BC3200X
Customized Equipment (DME)
AR-20331
AR
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
AR-20331
AR
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
AR-20331
AR
333600000X
Pharmacy
AR-20331
AR
3336C0003X
Community/Retail Pharmacy
AR-20331
AR
3336H0001X
Home Infusion Therapy Pharmacy
AR-20331
AR
3336L0003X
Long Term Care Pharmacy
AR-20331
AR
3336M0002X
Mail Order Pharmacy
AR-20331
AR
3336S0011X
Specialty Pharmacy
AR-20331
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115721716
—
AR
05
—
116277407
—
AR
01
—
4A032
BCBS
AR
Enumeration date
09/12/2006
Last updated
02/12/2016
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