Organization
PREMIER ONE PHARMA INC.
Active
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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