MEDICARE: PREMIUM HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1598504417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM HEALTH INC

Provider Business Mailing Address
First Line	:	320 S POLK ST STE 200
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79101-1436
Country	:	US
Telephone Number	:	806-242-7782
Fax Number	:	347-222-3198

Provider Business Practice Location Address
First Line	:	1212 SEAGIRT BOULEVARD
Second Line	:	SUITE 301
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4551
Country	:	US
Telephone Number	:	844-370-6199
Fax Number	:	347-222-3198

Authorized Official
Title or Position	:	PRESIDENT PHARMACY SERVICES
Name	:	JOEL WRIGHT
Credential	:
Telephone Number	:	806-242-7782

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	01/14/2026

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