Provider Demographics
NPI:1033115027
Name:PREMIER IV CARE INC.
Entity Type:Organization
Organization Name:PREMIER IV CARE INC.
Other - Org Name:NATIONS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VERN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-597-4950
Mailing Address - Street 1:PO BOX 6510
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-6510
Mailing Address - Country:US
Mailing Address - Phone:352-597-4950
Mailing Address - Fax:352-597-4553
Practice Address - Street 1:8269 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-4511
Practice Address - Country:US
Practice Address - Phone:352-597-4950
Practice Address - Fax:352-597-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH11651333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL297564OtherHIGHMARK BLUE SHIELD
FL501235OtherFEDERAL BLACK LUNG PROGRA
FLP6241OtherBC BS OF FLORIDA
FL0595780001Medicare ID - Type UnspecifiedMC PROVIDER NUMBER