NPIMap

Organization Active NPI

Professional Pharmacy LLC

  • Pharmacy
  • Colorado Springs, CO
National Provider Identifier
1013152198
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
754 Issued in CO
Legal business name
PROFESSIONAL PHARMACY LLC
Practice address
595 Chapel Hills Dr Ste 104
Colorado Springs, CO 80920-1024
Phone
(719) 633-8278
Fax
(719) 228-6911
NPI assigned
Dec 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ken Waterhouse
Title
Cfo
Phone
(719) 532-9705

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 754 CO Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

595 Chapel Hills Dr Ste 104
Colorado Springs, CO 80920-1024

Mailing address

595 Chapel Hills Dr Ste 104
Colorado Springs, CO 80920-1024
Phone (719) 633-8278

Other identifiers 2

IdentifierTypeStateIssuer
44283385MedicaidCO
2118132OtherPK

Other names 1

  • Professional Pharmacy, LLC Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1013152198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 CHAPEL HILLS DR STE 104",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809201024",
            "telephone_number": "719-633-8278",
            "fax_number": "719-228-6911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 CHAPEL HILLS DR STE 104",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809201024",
            "telephone_number": "719-633-8278",
            "fax_number": "719-228-6911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-03",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "WATERHOUSE",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "719-532-9705"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CO",
            "license": "754",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44283385",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2118132",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Professional Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.