Organization
PREMIUM PHARMACY SERVICES INC
Active
Other names
College Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VIVIAN AYUK RPH (PHARMACIST/OWNER/AO)
(240) 223-7064
Entity
Organization
Contact information
Practice address
4701 MELBOURNE PL, COLLEGE PARK, MD 20740-2540
(301) 474-0500
(301) 474-0550
Mailing address
4701 MELBOURNE PL, COLLEGE PARK, MD 20740-2540
(301) 474-0500
(301) 474-0550
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07420
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1159852
—
MD
01
—
2162506
PK
—
Enumeration date
07/12/2016
Last updated
04/12/2017
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