=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669026621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER PHARMACY & WELLNESS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2019
-----------------------------------------------------
Last Update Date | 12/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 BECKLEY CROSSING SHPG CTR
-----------------------------------------------------
City | BECKLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25801-7110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 681-207-8510
-----------------------------------------------------
Fax | 833-383-0026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 516 BECKLEY CROSSING SHPG CTR
-----------------------------------------------------
City | BECKLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25801-7110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 681-207-8510
-----------------------------------------------------
Fax | 833-383-0026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHARMACIST
-----------------------------------------------------
Name | KIMBERLY ANN MILLER
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 681-207-8510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------