MEDICARE: PREMIER PHARMA SERVICES INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH23612	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2117381	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700037587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PHARMA SERVICES INC

Provider Business Mailing Address
First Line	:	7520 W WATERS AVE
Second Line	:	SUITE 6
City	:	TAMPA
State	:	FL
Zip	:	33615-1599
Country	:	US
Telephone Number	:	813-333-5343
Fax Number	:	813-333-5274

Provider Business Practice Location Address
First Line	:	7520 W WATERS AVE
Second Line	:	SUITE 6
City	:	TAMPA
State	:	FL
Zip	:	33615-1599
Country	:	US
Telephone Number	:	813-333-5343
Fax Number	:	813-333-5274

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RENU TANEJA
Credential	:
Telephone Number	:	813-333-5343

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	12/08/2016

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