Organization
PREMIER COMPOUNDING PHARMACY INC
Active
Other names
Premier Custom Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY CHRISTIAN (PRES)
(561) 691-4991
Entity
Organization
Contact information
Practice address
2000 PGA BLVD STE 5507, STE 5507, PALM BEACH GARDENS, FL 33408-2726
(561) 691-4991
(561) 691-4998
Mailing address
2000 PGA BLVD, STE 5507, PALM BEACH GARDENS, FL 33408-2722
(561) 691-4991
(561) 691-4998
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH23481
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002422000
—
FL
01
—
2116428
PK
—
Enumeration date
08/04/2008
Last updated
06/16/2016
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