Provider Demographics
NPI:1306072160
Name:PROFESSIONAL PHARMACY, INC.
Entity type:Organization
Organization Name:PROFESSIONAL PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-300-3003
Mailing Address - Street 1:4415 OLD SHELL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1911
Mailing Address - Country:US
Mailing Address - Phone:251-300-3003
Mailing Address - Fax:251-300-3004
Practice Address - Street 1:4415 OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1911
Practice Address - Country:US
Practice Address - Phone:251-300-3003
Practice Address - Fax:251-300-3004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-08
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6337080001Medicare NSC