Healthcare Provider Details

I. General information

NPI: 1609032259
Provider Name (Legal Business Name): PREMIER COMPOUNDING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PGA BLVD STE 5507 STE 5507
PALM BEACH GARDENS FL
33408-2726
US

IV. Provider business mailing address

2000 PGA BLVD STE 5507
PALM BEACH GARDENS FL
33408-2722
US

V. Phone/Fax

Practice location:
  • Phone: 561-691-4991
  • Fax: 561-691-4998
Mailing address:
  • Phone: 561-691-4991
  • Fax: 561-691-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH23481
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TRACY CHRISTIAN
Title or Position: PRES
Credential:
Phone: 561-691-4991