Organization
PREMIER KIDS CARE, INC.
Active
Other names
Premier Care
Organization subpart
No
Provider details
NPI number
Authorized official
CHELLA LEICHT (CONTRACTS AND LICENSURE COORDINATOR)
(770) 207-9001
Entity
Organization
Contact information
Practice address
221 PLAZA DR, MONROE, GA 30655-3184
(770) 207-9001
(770) 207-8987
Mailing address
221 PLAZA DR, MONROE, GA 30655-3184
(770) 207-9001
(770) 207-8987
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHRE008225
GA
3336C0003X
Community/Retail Pharmacy
Primary
PHRE008225
GA
3336S0011X
Specialty Pharmacy
PHRE008225
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00712401B
—
GA
01
—
1145324
NABP #
GA
Enumeration date
03/08/2006
Last updated
01/02/2012
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