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General NPI Number Information
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NPI Number | 1922487867
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Entity Type | Organization
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Legal Business Name | PREMIER RX REPACKS, LLC
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 2000 PGA BLVD STE 5508
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33408-2726
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Country | US
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Telephone | 561-899-4429
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Fax | 855-367-6979
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Provider Business Mailing Address
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Address Line | 2000 PGA BLVD STE 5508
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33408-2726
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Country | US
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Telephone | 561-899-4429
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Fax | 855-367-6979
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Authorized Official
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Title or Position | PRES/CEO
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Name | TRACY CHRISTIAN
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Credential |
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Telephone | 561-899-4429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH28900
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License Number State | FL
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