1558406884 NPI number — PROFESSIONAL PHARMACY SERVICES

Table of content: (NPI 1558406884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558406884 NPI number — PROFESSIONAL PHARMACY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL PHARMACY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOOD DAY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558406884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3780 E 15TH ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80538-8766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-461-1975
Provider Business Mailing Address Fax Number:
970-461-4042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7702 FIFTH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80549-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-568-7282
Provider Business Practice Location Address Fax Number:
970-568-7529
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EINHELLIG
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-461-1975

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  677 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0620232 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87384876 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com