Organization
PREMIUM PHARMA, LLC
Active
Other names
The Pharmacy at Bergheim
Organization subpart
No
Provider details
NPI number
Authorized official
DUDLEY KLATT (VP OF OPERATIONS)
(361) 227-0412
Entity
Organization
Contact information
Practice address
1 FM 3351 S STE 115, BOERNE, TX 78006
(830) 336-2882
(830) 336-2883
Mailing address
1 FM 3351 S STE 115, BOERNE, TX 78006-5729
(830) 336-2882
(830) 336-2883
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31977
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177272
PK
—
Enumeration date
05/08/2018
Last updated
11/15/2018
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