Provider Demographics
NPI:1083227235
Name:PREMIUM HEALTH INC
Entity Type:Organization
Organization Name:PREMIUM HEALTH INC
Other - Org Name:PREMIUM RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-7782
Mailing Address - Street 1:320 S POLK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-1436
Mailing Address - Country:US
Mailing Address - Phone:806-242-7782
Mailing Address - Fax:929-387-3728
Practice Address - Street 1:4510 16TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1101
Practice Address - Country:US
Practice Address - Phone:844-370-6199
Practice Address - Fax:929-387-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06979006Medicaid