Organization
PREMIER ONE PHARMA INC.
Active
Other names
Lake Ridge Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DUNG NGUYEN (PHARMACY MANAGER)
(972) 522-7606
Entity
Organization
Contact information
Practice address
4927 LAKE RIDGE PKWY STE #180, GRAND PRAIRIE, TX 75052
(972) 522-7606
(972) 522-7607
Mailing address
4927 LAKE RIDGE PKWY STE #180, GRAND PRAIRIE, TX 75052
(972) 522-7606
(972) 522-7607
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28607
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146826
—
TX
01
—
2140442
PK
—
Enumeration date
04/22/2013
Last updated
11/03/2016
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