Organization
PREMIER SPECIALTY PHARMACY LLC
Active
Other names
Premier Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BUFFY GOUGELMANN (PHARMACIST IN CHARGE)
(770) 622-8901
Entity
Organization
Contact information
Practice address
11720 MEDLOCK BRIDGE RD STE 162, JOHNS CREEK, GA 30097-1513
(770) 622-8901
(770) 622-8900
Mailing address
335 LUM CROWE RD, ROSWELL, GA 30075-6879
(678) 478-8019
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010313
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166839
PK
—
Enumeration date
09/16/2016
Last updated
02/21/2017
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