MEDICARE: PREMIUM COMPOUNDING

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	3336C0004X	Compounding Pharmacy

General Provider Information

NPI Number	:	1972434819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM COMPOUNDING

Provider Business Mailing Address
First Line	:	3220 HIGHWAY 31 S STE A2
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-1731
Country	:	US
Telephone Number	:	865-789-0089
Fax Number	:	256-685-5138

Provider Business Practice Location Address
First Line	:	3220 HIGHWAY 31 S STE A2
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-1731
Country	:	US
Telephone Number	:	865-789-0089
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SAMUEL BORGHESE
Credential	:
Telephone Number	:	256-309-7451

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	06/03/2026

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Directions to “PREMIUM COMPOUNDING ” Practice Location

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