Provider Demographics
NPI:1083055891
Name:PREMIUM RX PHARMACY
Entity Type:Organization
Organization Name:PREMIUM RX PHARMACY
Other - Org Name:PHARMETRICS SPECIALTY RX OF SARASOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEDALINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:727-460-1855
Mailing Address - Street 1:2750 BAHIA VISTA ST.
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:727-460-1855
Mailing Address - Fax:
Practice Address - Street 1:2750 BAHIA VISTA ST
Practice Address - Street 2:SUITE 235
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2600
Practice Address - Country:US
Practice Address - Phone:727-460-1855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 26669333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy