Organization
PREMIER DRUGSTORE LLC
Active
Other names
Premier Drugstore
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN GREEN (PIC/PHARMACIST)
(678) 481-0925
Entity
Organization
Contact information
Practice address
8446 CAMPBELLTON ST, DOUGLASVILLE, GA 30134-1803
(770) 635-8509
(770) 675-7296
Mailing address
8446 CAMPBELLTON ST, DOUGLASVILLE, GA 30134-1803
(770) 635-8509
(770) 675-7296
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010286
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0037175653A
—
GA
01
—
2159731
PK
—
Enumeration date
04/23/2016
Last updated
04/17/2017
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