MEDICARE: EDMOND PREMIER DRUG LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1174473821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDMOND PREMIER DRUG LLC

Provider Business Mailing Address
First Line	:	1101 W 15TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3008
Country	:	US
Telephone Number	:	405-348-0220
Fax Number	:	405-348-0459

Provider Business Practice Location Address
First Line	:	1101 W 15TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3008
Country	:	US
Telephone Number	:	405-348-0220
Fax Number	:	405-348-0459

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. TIMOTHY ALAN GRUNDY
Credential	:	RPH
Telephone Number	:	405-401-3179

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “EDMOND PREMIER DRUG LLC ” Practice Location

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