Provider Demographics
NPI:1083767750
Name:PREMIER HEALTH PHARMACY-MVHN
Entity Type:Organization
Organization Name:PREMIER HEALTH PHARMACY-MVHN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NAPIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-6534
Mailing Address - Street 1:3170 KETTERING BLVD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-208-6534
Mailing Address - Fax:937-641-2363
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-734-5833
Practice Address - Fax:937-734-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022563750-033336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH103471Medicaid
3660532OtherNCPDP