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Organization
PREMIER COMPOUNDING PHARMACY INC
Active
Organization
PREMIER COMPOUNDING PHARMACY INC
Active
Other names
Premier Custom Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY CHRISTIAN (PRES)
(561) 691-4991
Entity
Organization
Contact information
Practice address
2000 PGA BLVD STE 5507, STE 5507, PALM BEACH GARDENS, FL 33408-2726
(561) 691-4991
(561) 691-4998
Mailing address
2000 PGA BLVD, STE 5507, PALM BEACH GARDENS, FL 33408-2722
(561) 691-4991
(561) 691-4998
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH23481
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002422000
—
FL
01
—
2116428
PK
—
Enumeration date
08/04/2008
Last updated
06/16/2016
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