Organization
PREMIUM PHARMA, LLC
Active
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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