Organization
PREMIERE HEALTHCARE LLC
Active
Other names
Medical Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP KEITH WILKINS SR. (PHARMACY OWNER)
(870) 931-9263
Entity
Organization
Contact information
Practice address
513 N GRAND AVE, DONIPHAN, MO 63935-1405
(573) 996-3784
Mailing address
513 N GRAND AVE, DONIPHAN, MO 63935-1405
(573) 996-3784
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
06/21/2010
Last updated
11/05/2010
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