Provider Demographics
NPI:1073198131
Name:PREMIER PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:PREMIER PHARMACY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-893-0290
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44610-0078
Mailing Address - Country:US
Mailing Address - Phone:330-893-0290
Mailing Address - Fax:
Practice Address - Street 1:2105 GLEN DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-8905
Practice Address - Country:US
Practice Address - Phone:234-301-9166
Practice Address - Fax:234-301-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0436163Medicaid