Organization
PREMIER PHARMACEUTICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY RUSSELL JOHNSON PT (OWNER)
(601) 888-7176
Entity
Organization
Contact information
Practice address
1348 US HIGHWAY 61 S, WOODVILLE, MS 39669-4560
(601) 888-7176
(601) 888-7134
Mailing address
PO BOX 1051, WOODVILLE, MS 39669-1051
(601) 888-7176
(601) 888-7134
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
05058 11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00440778
—
MS
05
—
0330599
—
MS
05
—
1268453
—
LA
05
—
1434850
—
LA
Enumeration date
12/11/2006
Last updated
08/22/2020
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