Healthcare Provider Details

I. General information

NPI: 1629514989
Provider Name (Legal Business Name): PREMIER SPECIALTY INFUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HASSELL RD STE 1525 SUITE #1525
HOFFMAN ESTATES IL
60169-2000
US

IV. Provider business mailing address

2401 HASSEL RD. SUITE 1525
HOFFMAN ESTATES IL
60169-7220
US

V. Phone/Fax

Practice location:
  • Phone: 877-629-4446
  • Fax: 877-599-0139
Mailing address:
  • Phone: 800-783-9655
  • Fax: 877-770-4179

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 Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN A LARIVIERE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 866-776-6782