Provider Demographics
NPI:1467758664
Name:PREMIER PHARMACY LLC
Entity Type:Organization
Organization Name:PREMIER PHARMACY LLC
Other - Org Name:PREMIER PHARMACY, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-644-7635
Mailing Address - Street 1:315 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2603
Mailing Address - Country:US
Mailing Address - Phone:931-520-6525
Mailing Address - Fax:931-528-8965
Practice Address - Street 1:315 N WASHINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2603
Practice Address - Country:US
Practice Address - Phone:931-520-6525
Practice Address - Fax:931-528-8965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48553336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4444143OtherNCPDP PROVIDER IDENTIFICATION NUMBER