Provider Demographics
NPI:1528240736
Name:PROFESSIONAL PHARMACY SERVICES AND DME INC.
Entity type:Organization
Organization Name:PROFESSIONAL PHARMACY SERVICES AND DME INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:PABLO
Authorized Official - Last Name:ROGES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:305-505-7486
Mailing Address - Street 1:10993 SW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6812
Mailing Address - Country:US
Mailing Address - Phone:305-253-6634
Mailing Address - Fax:305-253-6635
Practice Address - Street 1:10993 SW 186TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6812
Practice Address - Country:US
Practice Address - Phone:305-253-6634
Practice Address - Fax:305-253-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH230893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032356000Medicaid
FL6085650001Medicare NSC