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General NPI Number Information
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NPI Number | 1881143444
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL DISTRIBUTION
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 12393 S GATEWAY PARK PL SUITE 75
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City | DRAPER
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State | UT
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Zip | 84020-2309
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Country | US
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Telephone | 888-932-0019
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Fax | 801-542-0611
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Provider Business Mailing Address
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Address Line | 12393 S GATEWAY PARK PL SUITE 75
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City | DRAPER
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State | UT
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Zip | 84020-2309
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Country | US
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Telephone | 888-932-0019
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Fax | 801-542-0611
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JONATHAN DAVID WOOD
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Credential |
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Telephone | 801-285-0181
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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 | 81002311710
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License Number State | UT
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