Organization
PREMIER PHARMACY INC
Active
Organization
PREMIER PHARMACY INC
Active
Other names
Premier Pharmacy Inc
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH INGRAM (SECRETARY/TREASURER)
(423) 245-1022
Entity
Organization
Contact information
Practice address
109 JACK WHITE DR, KINGSPORT, TN 37664-2364
(423) 245-1022
(423) 245-6391
Mailing address
PO BOX 3563, KINGSPORT, TN 37664-0563
(423) 245-1022
(423) 245-6391
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5209
TN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141171
PK
—
Enumeration date
07/09/2013
Last updated
08/05/2015
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