Organization
PREMIUM FAMILY PHARMACY
Active
Other names
PREMIUM FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RIDDHAM TIBADIYA (OWNER)
(912) 271-1796
Entity
Organization
Contact information
Practice address
1776 TEASLEY LN STE 111, DENTON, TX 76205-7710
(940) 442-6767
(940) 442-6563
Mailing address
1776 TEASLEY LN STE 111, DENTON, TX 76205-7710
(940) 442-6767
(940) 442-6563
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27457
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2128958
PK
—
Enumeration date
01/30/2011
Last updated
04/17/2024
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