Provider Demographics
NPI:1346233251
Name:PREMIER HOME PHARMACY INC
Entity Type:Organization
Organization Name:PREMIER HOME PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-223-9734
Mailing Address - Street 1:27762 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2300
Mailing Address - Country:US
Mailing Address - Phone:248-223-9734
Mailing Address - Fax:248-223-9737
Practice Address - Street 1:27762 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2300
Practice Address - Country:US
Practice Address - Phone:248-223-9734
Practice Address - Fax:248-223-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0003X
MI5301007733251F00000X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1346233251Medicaid
MI4548930Medicaid