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General NPI Number Information
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NPI Number | 1174525075
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Entity Type | Organization
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Legal Business Name | PREMIUM PHARMACY SERVICES, INC.
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2805 W ARKANSAS LN SUITE 303
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City | ARLINGTON
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State | TX
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Zip | 76016-5725
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Country | US
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Telephone | 817-277-0405
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Fax | 817-277-0406
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Provider Business Mailing Address
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Address Line | 1700 TECH CENTRE PKWY SUITE 110
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City | ARLINGTON
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State | TX
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Zip | 76014-4405
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Country | US
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Telephone | 817-784-2400
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Fax | 817-676-9148
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Authorized Official
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Title or Position | ACCOUNTS COORDINATOR
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Name | MS. AYESHA SIDDIQI
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Credential |
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Telephone | 817-784-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 22238
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License Number State | TX
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